Provider Demographics
NPI:1790439941
Name:BLISS, JODI LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:BLISS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:HEPBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:322 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-1730
Mailing Address - Country:US
Mailing Address - Phone:610-960-8788
Mailing Address - Fax:484-460-2031
Practice Address - Street 1:322 VINCENT ST
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:PA
Practice Address - Zip Code:19475-1730
Practice Address - Country:US
Practice Address - Phone:610-960-8788
Practice Address - Fax:484-460-2031
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN300442164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty