Healthcare Provider Details

I. General information

NPI: 1285538058
Provider Name (Legal Business Name): VICTORIA BLANKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA BARKER LPN

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S 4TH ST
LEAVENWORTH KS
66048-5014
US

IV. Provider business mailing address

4101 S 4TH ST
LEAVENWORTH KS
66048-5014
US

V. Phone/Fax

Practice location:
  • Phone: 785-571-2079
  • Fax:
Mailing address:
  • Phone: 785-571-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number23-22428-052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: