Provider Demographics
NPI:1184693855
Name:BLEVINS, NANCY SUE (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:SUE
Other - Last Name:BLEVINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 2347
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-2347
Mailing Address - Country:US
Mailing Address - Phone:276-889-7621
Mailing Address - Fax:276-889-7621
Practice Address - Street 1:75 ROGERS STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-889-7621
Practice Address - Fax:276-889-7621
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001050105363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS78719Medicare UPIN