Healthcare Provider Details

I. General information

NPI: 1568056109
Provider Name (Legal Business Name): SANDRA BLANKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 COUNTY ROAD 667
HENAGAR AL
35978-4862
US

IV. Provider business mailing address

3208 COUNTY ROAD 667
HENAGAR AL
35978-4862
US

V. Phone/Fax

Practice location:
  • Phone: 256-996-8944
  • Fax:
Mailing address:
  • Phone: 256-996-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-121681
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: