Provider Demographics
NPI:1588239511
Name:BLEDSOE, VICTORIA CARMELLA
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:CARMELLA
Last Name:BLEDSOE
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 1:19319 STATE ROUTE 160
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:OH
Mailing Address - Zip Code:45686-9170
Mailing Address - Country:US
Mailing Address - Phone:740-395-6772
Mailing Address - Fax:
Practice Address - Street 1:19325 STATE ROUTE 160
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:OH
Practice Address - Zip Code:45686-9170
Practice Address - Country:US
Practice Address - Phone:740-395-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0440471Medicaid