Provider Demographics
NPI:1427248574
Name:BLODGETT, JANCI (LVN)
Entity type:Individual
Prefix:
First Name:JANCI
Middle Name:
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:JANCI
Other - Middle Name:
Other - Last Name:IDYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:2040 NUUANU AVE
Mailing Address - Street 2:#404
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2517
Mailing Address - Country:US
Mailing Address - Phone:951-634-5655
Mailing Address - Fax:
Practice Address - Street 1:2040 NUUANU AVE
Practice Address - Street 2:#404
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2517
Practice Address - Country:US
Practice Address - Phone:951-634-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN205220164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse