Provider Demographics
NPI:1548389968
Name:BLISS, ROXANNE B (ARNP)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:B
Last Name:BLISS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOPMEADOW ST UNIT 802
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-7937
Mailing Address - Country:US
Mailing Address - Phone:509-435-6083
Mailing Address - Fax:
Practice Address - Street 1:41 JUDGE LN
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:CT
Practice Address - Zip Code:06751-1902
Practice Address - Country:US
Practice Address - Phone:203-244-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12548363L00000X
WARN00114273363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner