Provider Demographics
NPI:1578072682
Name:BLEVINS, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
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 1:2230 MARY LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5100
Mailing Address - Country:US
Mailing Address - Phone:740-223-8514
Mailing Address - Fax:
Practice Address - Street 1:2230 MARY LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5100
Practice Address - Country:US
Practice Address - Phone:740-223-8514
Practice Address - Fax:740-223-8514
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health