Healthcare Provider Details

I. General information

NPI: 1568638526
Provider Name (Legal Business Name): PATRICIA C BLANK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 BIELBY RD
LAWRENCEBURG IN
47025-1055
US

IV. Provider business mailing address

285 BIELBY RD
LAWRENCEBURG IN
47025-1055
US

V. Phone/Fax

Practice location:
  • Phone: 812-537-1302
  • Fax: 812-537-5219
Mailing address:
  • Phone: 812-537-1302
  • Fax: 812-537-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28053149A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: