Healthcare Provider Details

I. General information

NPI: 1356427975
Provider Name (Legal Business Name): ELEANOR BLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 WOODLAWN DR
BALTIMORE MD
21207-4008
US

IV. Provider business mailing address

3019 MONDAWMIN AVE
BALTIMORE MD
21216-1904
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-1332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR096766
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: