Provider Demographics
NPI:1184681645
Name:BLEDSOE, BEVERLY STARNER (RN)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:STARNER
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1455
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:CA
Mailing Address - Zip Code:92386-1455
Mailing Address - Country:US
Mailing Address - Phone:760-247-4307
Mailing Address - Fax:
Practice Address - Street 1:10758 NAVAJO RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-8023
Practice Address - Country:US
Practice Address - Phone:760-247-4307
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544328163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis