Healthcare Provider Details

I. General information

NPI: 1558055053
Provider Name (Legal Business Name): DARIAN JADE BLANCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 BRAMBLEWOOD DR
LANSING MI
48917-8772
US

IV. Provider business mailing address

660 THURBER DR W
COLUMBUS OH
43215-1291
US

V. Phone/Fax

Practice location:
  • Phone: 231-388-3146
  • Fax:
Mailing address:
  • Phone: 231-388-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: