Provider Demographics
NPI:1093071284
Name:BLANKENSHIP, SCOTT JOEL (RN)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JOEL
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 CORAL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-2833
Mailing Address - Country:US
Mailing Address - Phone:937-559-3902
Mailing Address - Fax:
Practice Address - Street 1:2637 CORAL RIDGE CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-2833
Practice Address - Country:US
Practice Address - Phone:937-559-3902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH377244163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse