Provider Demographics
NPI:1275387532
Name:PSYCHIATRIC NURSING PRESCRIBER
Entity Type:Organization
Organization Name:PSYCHIATRIC NURSING PRESCRIBER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:415-605-5760
Mailing Address - Street 1:836 SOUTHAMPTON ROAD
Mailing Address - Street 2:STE B #115
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510
Mailing Address - Country:US
Mailing Address - Phone:415-605-5760
Mailing Address - Fax:
Practice Address - Street 1:1 SANSOME ST FL 35
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4436
Practice Address - Country:US
Practice Address - Phone:415-605-5760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty