Provider Demographics
NPI:1134491699
Name:BLANCHARD, DEVONA DIONE (RN)
Entity Type:Individual
Prefix:
First Name:DEVONA
Middle Name:DIONE
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11405 W GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2225
Mailing Address - Country:US
Mailing Address - Phone:414-551-1363
Mailing Address - Fax:
Practice Address - Street 1:11405 W GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2225
Practice Address - Country:US
Practice Address - Phone:414-551-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163673030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health