Provider Demographics
NPI:1467648915
Name:BLESS, ELIZABETH M (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:BLESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1982
Mailing Address - Country:US
Mailing Address - Phone:814-362-6536
Mailing Address - Fax:814-817-2113
Practice Address - Street 1:110 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1982
Practice Address - Country:US
Practice Address - Phone:814-362-6536
Practice Address - Fax:814-817-2113
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020244363LP0808X
NYF308813363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05552410Medicaid
PA1036404170002Medicaid