Healthcare Provider Details

I. General information

NPI: 1932596483
Provider Name (Legal Business Name): ASHLEY NICHOLE BLANKENSHIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GARLAND ST
EVERETT MA
02149-5066
US

IV. Provider business mailing address

103 GARLAND ST
EVERETT MA
02149-5066
US

V. Phone/Fax

Practice location:
  • Phone: 617-389-6270
  • Fax:
Mailing address:
  • Phone: 617-389-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number106906
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1626576
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberXXXXXXXXXXXXXXXXXXXX
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: