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General NPI Number Information
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NPI Number | 1942754387
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Entity Type | Individual
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Provider Name | LAURIE LYNN BLANCH CPNP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2016
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 1400 BROADFIELD BLVD STE 200
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City | HOUSTON
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State | TX
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Zip | 77084-5162
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Country | US
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Telephone | 914-919-9200
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Fax | 833-913-2393
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Provider Business Mailing Address
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Address Line | 275 AXIS CIR
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-2792
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Country | US
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Telephone | 512-787-7673
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP132192
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License Number State | TX
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