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General NPI Number Information
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NPI Number | 1194802561
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Entity Type | Individual
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Provider Name | MARILYN K BLANK RN, BN, MSN
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1303 BELLEFONTAINE AVE
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City | LIMA
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State | OH
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Zip | 45804-3109
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Country | US
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Telephone | 419-222-5788
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Fax | 419-222-9504
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Provider Business Mailing Address
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Address Line | 409 N JEFFERSON ST
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City | PANDORA
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State | OH
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Zip | 45877-9414
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Country | US
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Telephone | 419-384-3050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN187417
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License Number State | OH
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