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General NPI Number Information
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NPI Number | 1891432266
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Entity Type | Individual
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Provider Name | LANA J BLAGG
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Gender | Female
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 344 OAK CREEK ESTATES RD
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City | POTEET
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State | TX
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Zip | 78065-4019
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Country | US
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Telephone | 210-334-9230
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | POTEET
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State | TX
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Zip | 78065-0458
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Country | US
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Telephone | 210-334-9230
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 1069252
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1069252
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 1069252
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1069252
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License Number State | TX
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