Provider Demographics
NPI:1003357575
Name:BLUM, JENNIFER N
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:BLUM
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 1:3054 BUDDE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14737-9700
Mailing Address - Country:US
Mailing Address - Phone:716-258-0557
Mailing Address - Fax:
Practice Address - Street 1:3054 BUDDE RD
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NY
Practice Address - Zip Code:14737-9700
Practice Address - Country:US
Practice Address - Phone:716-258-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer