Provider Demographics
NPI:1285058354
Name:BLYLER, ANDREW
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:BLYLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SUNSHINE LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY VIEW
Mailing Address - State:PA
Mailing Address - Zip Code:17983-9769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 SUNSHINE LN
Practice Address - Street 2:
Practice Address - City:VALLEY VIEW
Practice Address - State:PA
Practice Address - Zip Code:17983-9769
Practice Address - Country:US
Practice Address - Phone:570-691-4607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE010069314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility