Provider Demographics
NPI:1407097009
Name:BLECKI, TAMMY JO (CNA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JO
Last Name:BLECKI
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13 W LIBERTY ST
Mailing Address - Street 2:27
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2709
Mailing Address - Country:US
Mailing Address - Phone:717-380-6092
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:180-087-9447
Practice Address - Fax:180-056-1201
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA9974282376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide