Provider Demographics
NPI:1669194692
Name:BHADSAVLE, LORETTA JEAN (MS, MSN, ACNPC-AG)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:JEAN
Last Name:BHADSAVLE
Suffix:
Gender:F
Credentials:MS, MSN, ACNPC-AG
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:JEAN
Other - Last Name:SUTHERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MSN, ACNPC-AG
Mailing Address - Street 1:4004 EULA CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2534
Mailing Address - Country:US
Mailing Address - Phone:419-296-0978
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3050
Practice Address - Country:US
Practice Address - Phone:404-616-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225224363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care