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General NPI Number Information
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NPI Number | 1275900342
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Entity Type | Individual
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Provider Name | ADELLA BLONDET
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Gender | Female
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 4900 BROADWAY
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City | GARY
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State | IN
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Zip | 46408-4605
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Country | US
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Telephone | 219-237-5170
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Fax | 219-321-1931
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Provider Business Mailing Address
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Address Line | 213 N RACINE AVE SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60607-1644
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Country | US
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Telephone | 312-733-9730
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Fax | 773-866-8014
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.011604
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License Number State | IL
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