Provider Demographics
NPI:1770775058
Name:BLUHM, IVANA JANICE (NP)
Entity type:Individual
Prefix:MRS
First Name:IVANA
Middle Name:JANICE
Last Name:BLUHM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 TERRACINA BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4850
Mailing Address - Country:US
Mailing Address - Phone:909-335-5500
Mailing Address - Fax:
Practice Address - Street 1:802 W COLTON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2905
Practice Address - Country:US
Practice Address - Phone:909-335-5799
Practice Address - Fax:909-793-6614
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily