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General NPI Number Information
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NPI Number | 1982110722
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Entity Type | Individual
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Provider Name | RACHAEL LYNN BLEA PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 12660 TEN MILE RD
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City | SOUTH LYON
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State | MI
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Zip | 48178-9141
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Country | US
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Telephone | 248-348-1131
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Fax | 248-348-1171
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Provider Business Mailing Address
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Address Line | PO BOX 27420
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City | BELFAST
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State | ME
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Zip | 04915-2026
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Country | US
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Telephone | 586-216-7423
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Fax | 248-327-1261
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0005225
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601010532
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License Number State | MI
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