Provider Demographics
NPI:1598943805
Name:BLILIE, JEANNIE C (RNP)
Entity Type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:C
Last Name:BLILIE
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1855 W KATELLA AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3451
Mailing Address - Country:US
Mailing Address - Phone:714-399-3480
Mailing Address - Fax:714-399-3481
Practice Address - Street 1:1530 E 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6307
Practice Address - Country:US
Practice Address - Phone:714-972-3700
Practice Address - Fax:714-972-3766
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN375310363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health