Provider Demographics
NPI:1659666212
Name:BLAY-WHADJAH, BLISSPAUL
Entity Type:Individual
Prefix:
First Name:BLISSPAUL
Middle Name:
Last Name:BLAY-WHADJAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 WETHERLY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45065-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5534 WETHERLY DR
Practice Address - Street 2:
Practice Address - City:SOUTH LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45065-5002
Practice Address - Country:US
Practice Address - Phone:513-282-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide