Provider Demographics
NPI:1932420239
Name:BLANDAMER, MILDRED A (FAMILY PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:A
Last Name:BLANDAMER
Suffix:
Gender:F
Credentials:FAMILY PMHNP-BC
Other - Prefix:MS
Other - First Name:MILDRED (MIDGE)
Other - Middle Name:A
Other - Last Name:BLANDAMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, CRNP
Mailing Address - Street 1:8108 E NORMAN ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-7414
Mailing Address - Country:US
Mailing Address - Phone:918-316-9353
Mailing Address - Fax:918-517-2922
Practice Address - Street 1:BRIGHTSIDE HEALTH TELEPSYCHIATRY
Practice Address - Street 2:2261 MARKET STREET, SUITE 10222
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114
Practice Address - Country:US
Practice Address - Phone:918-762-6604
Practice Address - Fax:918-762-6646
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5400363LP0808X, 363LP0808X
OK34370363LP0808X
AL34334363LP0808X
UT4405363LP0808X
MT154915363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health