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General NPI Number Information
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NPI Number | 1124193990
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Entity Type | Individual
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Provider Name | JILL BLODGET FNP
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2345 FAIR OAKS BOULEVARD STATION 4
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City | SACRAMENTO
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State | CA
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Zip | 95825
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Country | US
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Telephone | 916-480-6433
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 BROOKSIDE RD
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City | CAMERON PARK
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State | CA
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Zip | 95682-9692
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 10080
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License Number State | CA
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