Healthcare Provider Details

I. General information

NPI: 1427625078
Provider Name (Legal Business Name): VICTORIA BLANKENSHIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 PACER DR NW
CORYDON IN
47112-2145
US

IV. Provider business mailing address

3912 LEES LN
LOUISVILLE KY
40216-2023
US

V. Phone/Fax

Practice location:
  • Phone: 812-738-0317
  • Fax: 812-738-0318
Mailing address:
  • Phone: 502-403-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number28196317A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: