Provider Demographics
NPI:1518273622
Name:BLANSHAN, SARAH E (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:BLANSHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:DILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IOTA
Mailing Address - State:LA
Mailing Address - Zip Code:70543-6044
Mailing Address - Country:US
Mailing Address - Phone:337-779-6000
Mailing Address - Fax:
Practice Address - Street 1:119 S 5TH ST
Practice Address - Street 2:
Practice Address - City:IOTA
Practice Address - State:LA
Practice Address - Zip Code:70543-6044
Practice Address - Country:US
Practice Address - Phone:337-779-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 173680-7363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP01021776OtherRAILROAD MEDICARE
MNP01021776OtherRAILROAD MEDICARE