Provider Demographics
NPI:1124576095
Name:MATTHEWS, BLESSING JIM (MBPA, BS, BSN, RN)
Entity Type:Individual
Prefix:
First Name:BLESSING JIM
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MBPA, BS, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2924
Mailing Address - Country:US
Mailing Address - Phone:240-770-7774
Mailing Address - Fax:240-770-3161
Practice Address - Street 1:8855 ANNAPOLIS RD
Practice Address - Street 2:SUITE 305
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2924
Practice Address - Country:US
Practice Address - Phone:240-770-7774
Practice Address - Fax:240-770-3161
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR129320163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice