Provider Demographics
NPI:1770063679
Name:BIANCHI, LEDIA SUSANNE
Entity type:Individual
Prefix:
First Name:LEDIA
Middle Name:SUSANNE
Last Name:BIANCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MIRASOL DR
Mailing Address - Street 2:
Mailing Address - City:SANDIA
Mailing Address - State:TX
Mailing Address - Zip Code:78383
Mailing Address - Country:US
Mailing Address - Phone:361-207-1452
Mailing Address - Fax:
Practice Address - Street 1:4444 CORONA DRIVE
Practice Address - Street 2:SUITE 144
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-854-1110
Practice Address - Fax:855-448-9769
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX838613163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse