MEDICARE: JUDITH C BLIND FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN 291392	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013001510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH C BLIND FNP

Provider Business Mailing Address
First Line	:	1519 S OREGON ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-3425
Country	:	US
Telephone Number	:	530-484-2920
Fax Number	:	530-484-9207

Provider Business Practice Location Address
First Line	:	1519 S OREGON ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-3425
Country	:	US
Telephone Number	:	530-842-9200
Fax Number	:	530-842-9207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/21/2012

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