Healthcare Provider Details

I. General information

NPI: 1396137477
Provider Name (Legal Business Name): JENNIFER BLUSH RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER NIZIOLEK RN

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SAVANNAH RD
LEWES DE
19958-1462
US

IV. Provider business mailing address

20316 ROBINSONVILLE RD
LEWES DE
19958-4560
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3728
  • Fax:
Mailing address:
  • Phone: 302-245-4216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0043768
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-96486
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: