Provider Demographics
NPI:1558002675
Name:DEMELLO, BLYTHE (DNP)
Entity Type:Individual
Prefix:
First Name:BLYTHE
Middle Name:
Last Name:DEMELLO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 W SAINT MARYS RD STE 275
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2629
Mailing Address - Country:US
Mailing Address - Phone:520-276-2270
Mailing Address - Fax:
Practice Address - Street 1:1707 W SAINT MARYS RD STE 275
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2629
Practice Address - Country:US
Practice Address - Phone:520-276-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1655150163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine