MEDICARE: SONJI M BLANCHARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1194334144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJI M BLANCHARD

Provider Business Mailing Address
First Line	:	8553 N BEACH ST STE 224
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4919
Country	:	US
Telephone Number	:	817-701-8283
Fax Number	:

Provider Business Practice Location Address
First Line	:	8553 N BEACH ST STE 224
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4919
Country	:	US
Telephone Number	:	817-701-8283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	09/14/2020

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Directions to “ SONJI M BLANCHARD ” Practice Location

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