Provider Demographics
NPI:1326641028
Name:BLEVINS, CHLORISA RENEA
Entity Type:Individual
Prefix:
First Name:CHLORISA
Middle Name:RENEA
Last Name:BLEVINS
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 1:713 S OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5968
Mailing Address - Country:US
Mailing Address - Phone:304-254-8420
Mailing Address - Fax:
Practice Address - Street 1:204 PAMELA ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880-8847
Practice Address - Country:US
Practice Address - Phone:304-877-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant