Provider Demographics
NPI:1831874205
Name:BLOEDEL, CAMRYN NICOLE (RN)
Entity type:Individual
Prefix:
First Name:CAMRYN
Middle Name:NICOLE
Last Name:BLOEDEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANJELICA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2349 ROCKY STEP RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-7058
Mailing Address - Country:US
Mailing Address - Phone:304-941-8997
Mailing Address - Fax:
Practice Address - Street 1:1200 WV-34
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526
Practice Address - Country:US
Practice Address - Phone:304-202-3864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001237155163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse