Provider Demographics
NPI:1487258349
Name:BLAISDELL, NONA JO
Entity type:Individual
Prefix:
First Name:NONA
Middle Name:JO
Last Name:BLAISDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 CHESTNUT LANE
Mailing Address - Street 2:POBOX 703
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523
Mailing Address - Country:US
Mailing Address - Phone:701-870-1243
Mailing Address - Fax:
Practice Address - Street 1:1113 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523-6426
Practice Address - Country:US
Practice Address - Phone:701-870-1243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant