Provider Demographics
NPI:1770157992
Name:BLIEMEISTER, AMANDA NICHOLE (PHD, MSN, CNP-BC, RN)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:NICHOLE
Last Name:BLIEMEISTER
Suffix:
Gender:F
Credentials:PHD, MSN, CNP-BC, RN
Other - Prefix:
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Other - Middle Name:
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Other - Suffix:
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Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:616-828-3490
Mailing Address - Fax:
Practice Address - Street 1:1050 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-7980
Practice Address - Fax:740-383-3040
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN423698163W00000X
OHAPRN.CNP.0028551363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse