1093780272 NPI number — MRS. KAREN RUTH BLEWITT RN, MS, APRN

Table of content: MRS. KAREN RUTH BLEWITT RN, MS, APRN (NPI 1093780272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093780272 NPI number — MRS. KAREN RUTH BLEWITT RN, MS, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLEWITT
Provider First Name:
KAREN
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MS, APRN
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:
1093780272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8931 COLONIAL CENTER DR.
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-343-9568
Provider Business Mailing Address Fax Number:
239-343-9506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8931 COLONIAL CENTER DR.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-343-9568
Provider Business Practice Location Address Fax Number:
239-343-9506
Provider Enumeration Date:
02/21/2006

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: 363L00000X , with the licence number:  L10025993 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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