Healthcare Provider Details

I. General information

NPI: 1043372725
Provider Name (Legal Business Name): DYLAN BLANKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DYLAN LAVON BLANKS RN

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 GOODPASTURE ISLAND RD
EUGENE OR
97401-1712
US

IV. Provider business mailing address

1530 GOODPASTURE ISLAND RD
EUGENE OR
97401-1712
US

V. Phone/Fax

Practice location:
  • Phone: 541-465-2258
  • Fax: 541-485-8235
Mailing address:
  • Phone: 541-465-2258
  • Fax: 541-485-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: