Provider Demographics
NPI:1649524422
Name:BLEVINS, DUSTIN E (MS, CNIM)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:E
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:MS, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 CORPORATE WAY STE 212
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9560
Mailing Address - Country:US
Mailing Address - Phone:513-947-8433
Mailing Address - Fax:513-947-9943
Practice Address - Street 1:8118 CORPORATE WAY STE 212
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-947-8433
Practice Address - Fax:513-947-9943
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3573246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic