Provider Demographics
NPI:1699388553
Name:LEXINE-KOCH, BLONDYNE (RN)
Entity Type:Individual
Prefix:
First Name:BLONDYNE
Middle Name:
Last Name:LEXINE-KOCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6933
Mailing Address - Country:US
Mailing Address - Phone:908-468-1433
Mailing Address - Fax:
Practice Address - Street 1:879 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6933
Practice Address - Country:US
Practice Address - Phone:908-468-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care