Healthcare Provider Details

I. General information

NPI: 1306752498
Provider Name (Legal Business Name): KIMBERLI SUZANNE BLASCHAK BSN, RN, LSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMI SUZANNE BLASCHAK BSN, RN, LSN

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FEEDWIRE RD
BELLBROOK OH
45305-9704
US

IV. Provider business mailing address

3600 FEEDWIRE RD
BELLBROOK OH
45305-9704
US

V. Phone/Fax

Practice location:
  • Phone: 937-848-2141
  • Fax:
Mailing address:
  • Phone: 937-848-2141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN231455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: