Healthcare Provider Details

I. General information

NPI: 1568854347
Provider Name (Legal Business Name): BLUFFTON PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E JEFFERON STREET SUITE A
BLUFFTON OH
45817
US

IV. Provider business mailing address

505 E JEFFERON STREET SUITE A
BLUFFTON OH
45817-1349
US

V. Phone/Fax

Practice location:
  • Phone: 419-549-5865
  • Fax: 567-226-1055
Mailing address:
  • Phone: 419-549-5865
  • Fax: 567-226-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA08524NP
License Number StateOH

VIII. Authorized Official

Name: MRS. BETH A BISH
Title or Position: NURSE PRACTITIONER
Credential: CNP
Phone: 419-549-5865