Healthcare Provider Details

I. General information

NPI: 1205173911
Provider Name (Legal Business Name): MEGHAN BLANKMANN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N EUGENE ST
GREENSBORO NC
27401-2221
US

IV. Provider business mailing address

350 PEE DEE AVE STE 101
ALBEMARLE NC
28001-4945
US

V. Phone/Fax

Practice location:
  • Phone: 336-676-6840
  • Fax:
Mailing address:
  • Phone: 704-986-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number22 545597
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberMB2889799
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5006145
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: