Provider Demographics
NPI:1598429888
Name:BLEDSOE, COURTNEY (CAA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:LASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAA
Mailing Address - Street 1:4250 CHAMPLIN DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7176
Mailing Address - Country:US
Mailing Address - Phone:812-698-8847
Mailing Address - Fax:
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-383-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant