Healthcare Provider Details

I. General information

NPI: 1902739600
Provider Name (Legal Business Name): MAGGIE BLANKENSHIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41175 E VILLAGE GREEN BLVD APT 202
CANTON MI
48187-3885
US

IV. Provider business mailing address

41175 E VILLAGE GREEN BLVD APT 202
CANTON MI
48187-3885
US

V. Phone/Fax

Practice location:
  • Phone: 276-692-6628
  • Fax: 276-692-6628
Mailing address:
  • Phone: 276-692-6628
  • Fax: 276-692-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: