Provider Demographics
NPI:1295465417
Name:BLASDELL, JILL GLAZIER
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:GLAZIER
Last Name:BLASDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 WHIPPLE AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:LOGANDALE
Mailing Address - State:NV
Mailing Address - Zip Code:89021-9934
Mailing Address - Country:US
Mailing Address - Phone:702-398-3621
Mailing Address - Fax:
Practice Address - Street 1:1925 WHIPPLE AVE STE 30
Practice Address - Street 2:
Practice Address - City:LOGANDALE
Practice Address - State:NV
Practice Address - Zip Code:89021-9934
Practice Address - Country:US
Practice Address - Phone:702-398-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV856084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily