Provider Demographics
NPI:1770241788
Name:BLUNDELL, JAMES EDWARD
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:BLUNDELL
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:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:BENEDICT
Mailing Address - State:NE
Mailing Address - Zip Code:68316-0034
Mailing Address - Country:US
Mailing Address - Phone:402-363-2385
Mailing Address - Fax:
Practice Address - Street 1:202 LOVENA AVE
Practice Address - Street 2:
Practice Address - City:BENEDICT,
Practice Address - State:NE
Practice Address - Zip Code:68316-0034
Practice Address - Country:US
Practice Address - Phone:402-363-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver