Provider Demographics
NPI:1629277264
Name:BLANTON, NINA ELMORE (RN MN CWOCN)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:ELMORE
Last Name:BLANTON
Suffix:
Gender:F
Credentials:RN MN CWOCN
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Mailing Address - Street 1:100 BRASSFIELD COURT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:803-296-8906
Mailing Address - Fax:803-296-8908
Practice Address - Street 1:1333 TAYLOR STREET, SUITE 4E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29220
Practice Address - Country:US
Practice Address - Phone:803-296-8906
Practice Address - Fax:803-296-8908
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC17577163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC17577OtherSTATE RN LICENSE