1013059559 NPI number — DEBORAH ELAINE BLISS ACNP

Table of content: DEBORAH ELAINE BLISS ACNP (NPI 1013059559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013059559 NPI number — DEBORAH ELAINE BLISS ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLISS
Provider First Name:
DEBORAH
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013059559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 THOMAS MORE PARKWAY
Provider Second Line Business Mailing Address:
ST. ELIZABETH HEALTHCARE, SUITE 280
Provider Business Mailing Address City Name:
CRESTVIEW HILLS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-426-0800
Provider Business Mailing Address Fax Number:
859-578-0222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL VILLAGE DRIVE
Provider Second Line Business Practice Location Address:
ST. ELIZABETH HEALTHCARE
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-2000
Provider Business Practice Location Address Fax Number:
859-301-6900
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  NP-3855P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: COA.06835-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP-06835 . This is a "OHIO NP LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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