Individual
MS. JUDITH M BLICKENSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2825 EAST BARNETT RD, MEDFORD, OR 97504-8332
(541) 789-7000
(541) 774-7954
Mailing address
PO BOX 4749, MEDFORD, OR 97501-0227
(541) 789-5516
(541) 789-5518
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
079043756NI
OR
363LF0000X
Family Nurse Practitioner
079043756N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034681
—
OR
Enumeration date
11/03/2006
Last updated
07/09/2015
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