Healthcare Provider Details

I. General information

NPI: 1831480086
Provider Name (Legal Business Name): LINDA BLEDSOE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8777 PURDUE RD STE 300
INDIANAPOLIS IN
46268-6112
US

IV. Provider business mailing address

8777 PURDUE RD STE 300
INDIANAPOLIS IN
46268-6112
US

V. Phone/Fax

Practice location:
  • Phone: 317-755-4017
  • Fax: 317-755-4012
Mailing address:
  • Phone: 317-755-4017
  • Fax: 317-755-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28145190A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: