1710949375 NPI number — MRS. JANET ELLEN BLEDSOE MSN,APRN,BC,CRNP

Table of content: MRS. JANET ELLEN BLEDSOE MSN,APRN,BC,CRNP (NPI 1710949375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710949375 NPI number — MRS. JANET ELLEN BLEDSOE MSN,APRN,BC,CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLEDSOE
Provider First Name:
JANET
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN,APRN,BC,CRNP
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:
1710949375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21260 ALLIGATOR ALY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-6812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-610-7336
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 FOULK RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19803-3820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-762-2285
Provider Business Practice Location Address Fax Number:
302-762-2286
Provider Enumeration Date:
04/06/2006

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: 163WP0808X , with the licence number:  L1-0040997 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: L8-0000113 , 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)

  • Identifier: AN-0008456 . This is a "CSR" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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