Provider Demographics
NPI:1598367757
Name:BLUDNICK, DANETTE M (CRT)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:M
Last Name:BLUDNICK
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22952 BOLENDER PONTIUS RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9040
Mailing Address - Country:US
Mailing Address - Phone:740-525-6298
Mailing Address - Fax:
Practice Address - Street 1:22952 BOLENDER PONTIUS RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9040
Practice Address - Country:US
Practice Address - Phone:740-525-6298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65028133747A0650X, 3747P1801X, 385H00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6502813OtherDODD INDEPENDENT PROVIDER