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General NPI Number Information
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NPI Number | 1881469559
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Entity Type | Organization
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Legal Business Name | BLEI GROUP LLC
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Dates
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Enumeration Date | 11/22/2023
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | 825 FLORIDA AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-2335
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Country | US
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Telephone | 850-265-3686
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Fax |
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Provider Business Mailing Address
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Address Line | 6103 EDITH STEPHENS DR
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City | PANAMA CITY
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State | FL
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Zip | 32404-1933
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Country | US
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Telephone | 850-774-9535
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DESTINEE BERTIA BLEI
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Credential | AGNP
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Telephone | 850-774-9535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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