Provider Demographics
NPI:1083854160
Name:BLANKS, RACHEL (LPN)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:BLANKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 BROOKWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215
Mailing Address - Country:US
Mailing Address - Phone:646-234-3779
Mailing Address - Fax:678-593-5148
Practice Address - Street 1:170 BROOKWOOD LANE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215
Practice Address - Country:US
Practice Address - Phone:646-234-3779
Practice Address - Fax:678-593-5148
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231245164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse