Provider Demographics
NPI:1437534674
Name:BLANTON, INA
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:
Last Name:BLANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S PADDOCK ST
Mailing Address - Street 2:APT 10
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-3179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 S PADDOCK ST
Practice Address - Street 2:APT 10
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-3179
Practice Address - Country:US
Practice Address - Phone:586-404-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide