Healthcare Provider Details

I. General information

NPI: 1104479005
Provider Name (Legal Business Name): MARCI MARIE BLANKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8325 BRIMHALL RD STE 100
BAKERSFIELD CA
93312-2245
US

IV. Provider business mailing address

8303 BRIMHALL RD BLDG 1500
BAKERSFIELD CA
93312-2243
US

V. Phone/Fax

Practice location:
  • Phone: 661-679-6720
  • Fax:
Mailing address:
  • Phone: 661-587-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012838
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95051078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: