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General NPI Number Information
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NPI Number | 1427944743
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Entity Type | Individual
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Provider Name | LARRY NATHANIEL BLANKENSHIP AUD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 7926 W JEFFERSON BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-4140
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Country | US
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Telephone | 260-469-6919
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 E 360 N
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City | ANDERSON
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State | IN
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Zip | 46012-9611
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Country | US
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Telephone | 765-639-2956
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 23002915A
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License Number State | IN
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