Healthcare Provider Details

I. General information

NPI: 1518272806
Provider Name (Legal Business Name): ESTILL LEO BLEVINS LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 METRO PL N STE 300
DUBLIN OH
43017-5320
US

IV. Provider business mailing address

525 METRO PL N STE 300
DUBLIN OH
43017-5320
US

V. Phone/Fax

Practice location:
  • Phone: 855-289-1722
  • Fax:
Mailing address:
  • Phone: 855-289-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.100044.MEDS
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberPN100044
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: