MEDICARE: SAVANNAH FAITH 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1730946112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH FAITH BLANKENSHIP

Provider Business Mailing Address
First Line	:	6434 S 82ND EAST AVE APT 807
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-2355
Country	:	US
Telephone Number	:	918-935-4865
Fax Number	:

Provider Business Practice Location Address
First Line	:	12710 STATE FARM BLVD
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-5403
Country	:	US
Telephone Number	:	918-587-9471
Fax Number	:

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

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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