Provider Demographics
NPI:1487953550
Name:BLISTAN, ROBERTA I (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:I
Last Name:BLISTAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:I
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:3101 BURNET AVENUE
Mailing Address - Street 2:ROOM 116
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3014
Mailing Address - Country:US
Mailing Address - Phone:513-357-7289
Mailing Address - Fax:513-357-7290
Practice Address - Street 1:3101 BURNET AVENUE
Practice Address - Street 2:ROOM 116
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3014
Practice Address - Country:US
Practice Address - Phone:513-357-7289
Practice Address - Fax:513-357-7290
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN2101170163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse