MEDICARE: MRS. DONNA SUE BLANEY NON-AGENCY PROVIDER

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	3747P1801X	Personal Care Attendant	DOES NOT APPLY	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

General Provider Information

NPI Number	:	1396756599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA SUE BLANEY NON-AGENCY PROVIDER

Provider Business Mailing Address
First Line	:	63321 S JOHNSON RD
Second Line	:
City	:	BETHESDA
State	:	OH
Zip	:	43719-9703
Country	:	US
Telephone Number	:	740-484-1180
Fax Number	:	740-484-1180

Provider Business Practice Location Address
First Line	:	68205 COMMERCIAL DR
Second Line	:	APT. H2
City	:	BRIDGEPORT
State	:	OH
Zip	:	43912-1566
Country	:	US
Telephone Number	:	740-633-0258
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/09/2007

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