Provider Demographics
NPI:1538934682
Name:BLUDSAW, KEIANDRA V
Entity type:Individual
Prefix:
First Name:KEIANDRA
Middle Name:V
Last Name:BLUDSAW
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 1:204 ROSE HILL DR
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-2502
Mailing Address - Country:US
Mailing Address - Phone:609-674-3647
Mailing Address - Fax:
Practice Address - Street 1:204 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-2502
Practice Address - Country:US
Practice Address - Phone:609-674-3647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR23811500163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult