MEDICARE: VICTORIA BLANKENSHIP

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	364SL0600X	Long-Term Care Clinical Nurse Specialist	28196317A	IN

General Provider Information

NPI Number	:	1427625078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA BLANKENSHIP

Provider Business Mailing Address
First Line	:	3912 LEES LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-2023
Country	:	US
Telephone Number	:	502-403-7887
Fax Number	:

Provider Business Practice Location Address
First Line	:	871 PACER DR NW
Second Line	:
City	:	CORYDON
State	:	IN
Zip	:	47112-2145
Country	:	US
Telephone Number	:	812-738-0317
Fax Number	:	812-738-0318

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

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	06/10/2021

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Directions to “ VICTORIA BLANKENSHIP ” Practice Location

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