Healthcare Provider Details

I. General information

NPI: 1518462811
Provider Name (Legal Business Name): JO ALICE BLAND-HOLLFELDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 S I 35
AUSTIN TX
78704
US

IV. Provider business mailing address

1524 S I 35
AUSTIN TX
78704
US

V. Phone/Fax

Practice location:
  • Phone: 512-382-0222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number251398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: