Provider Demographics
NPI:1154637908
Name:BLANCHARD, ROBERT DALE (RN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DALE
Last Name:BLANCHARD
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 1:1178 S PARK GROVE CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-0914
Mailing Address - Country:US
Mailing Address - Phone:480-857-9848
Mailing Address - Fax:
Practice Address - Street 1:1876 E SABIN DR
Practice Address - Street 2:BUILDING A
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6197
Practice Address - Country:US
Practice Address - Phone:520-836-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN092547163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health