=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336014752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYLEIGH BLAKLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2025
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 N DUKE ST STE 244
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17602-2374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-826-9770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 VILLAGE DR
-----------------------------------------------------
City | MOUNTVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17554-1716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-826-9770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP034028
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------