Individual
DR. JANELLE RUTH BLICKENSDERFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
515 N LAFAYETTE BLVD, SOUTH BEND, IN 46601-1003
(574) 232-2037
(574) 232-1420
Mailing address
515 N LAFAYETTE BLVD, SOUTH BEND, IN 46601-1003
(574) 232-2037
(574) 232-1420
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
02001307A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100339290A
—
IN
Enumeration date
05/17/2006
Last updated
02/10/2010
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