Provider Demographics
NPI:1265866701
Name:BLUST, JESSICA DANIELLE (LPN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:BLUST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 KENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:VILLA HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1155
Mailing Address - Country:US
Mailing Address - Phone:513-237-8283
Mailing Address - Fax:
Practice Address - Street 1:907 KENRIDGE DR
Practice Address - Street 2:
Practice Address - City:VILLA HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:513-237-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.138705-M-IV164W00000X
KY2046175164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse