Provider Demographics
NPI:1255306056
Name:BLOSSER, JANE (RD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BLOSSER
Suffix:
Gender:F
Credentials:RD
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 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-4708
Mailing Address - Fax:540-932-5642
Practice Address - Street 1:79 N MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2344
Practice Address - Country:US
Practice Address - Phone:540-932-4708
Practice Address - Fax:540-932-5642
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA710000426OtherPALMETTO
VA180330OtherSOUTHERN HEALTH
VAC06769Medicare PIN
VAGC1100Medicare PIN
VA710000426OtherPALMETTO
VA180330OtherSOUTHERN HEALTH