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 1:329 S 350 E STE 4
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3768
Mailing Address - Country:US
Mailing Address - Phone:435-644-5626
Mailing Address - Fax:
Practice Address - Street 1:329 S 350 E STE 4
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3768
Practice Address - Country:US
Practice Address - Phone:435-644-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7742638-8900363LF0000X
NV856084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily