Provider Demographics
NPI:1851749394
Name:BLEDSOE, MICHELLE ALISE (CNA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ALISE
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9298
Mailing Address - Country:US
Mailing Address - Phone:816-288-2906
Mailing Address - Fax:
Practice Address - Street 1:218 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9298
Practice Address - Country:US
Practice Address - Phone:816-288-2906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO82795A376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide