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General NPI Number Information
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NPI Number | 1578251344
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Entity Type | Individual
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Provider Name | MORGHEN RYLEE BLEVINS
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Gender | Female
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 714 HENRIETTA ST
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City | JACKSON
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State | MI
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Zip | 49203-2171
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Country | US
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Telephone | 517-240-0167
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Fax |
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Provider Business Mailing Address
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Address Line | 505 N JACKSON ST
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City | JACKSON
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State | MI
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Zip | 49201-1266
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Country | US
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Telephone | 517-748-5445
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Fax | 517-787-0852
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902019956
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License Number State | MI
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