MEDICARE: MARY B BLANKENSHIP CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP06557	OH
2	363LF0000X	Family Nurse Practitioner	022224	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043272404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY B BLANKENSHIP CFNP

Provider Business Mailing Address
First Line	:	305 N 5TH ST
Second Line	:
City	:	IRONTON
State	:	OH
Zip	:	45638-1578
Country	:	US
Telephone Number	:	740-532-4858
Fax Number	:	740-532-4859

Provider Business Practice Location Address
First Line	:	13804 STATE ROUTE 141
Second Line	:
City	:	KITTS HILL
State	:	OH
Zip	:	45645-8848
Country	:	US
Telephone Number	:	740-643-2082
Fax Number	:	740-643-2126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	04/25/2019

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