Provider Demographics
NPI:1093147829
Name:BLANKENSHIP, JOHN (RN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
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 1:109 LYTTLETON LN
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-2315
Mailing Address - Country:US
Mailing Address - Phone:434-546-1504
Mailing Address - Fax:
Practice Address - Street 1:109 LYTTLETON LN
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2315
Practice Address - Country:US
Practice Address - Phone:434-546-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001224739390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program