Provider Demographics
NPI:1629822663
Name:BLANTON, ELEANOR JANE
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:JANE
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 1:1791 MADDEN RD
Mailing Address - Street 2:
Mailing Address - City:CABLE
Mailing Address - State:OH
Mailing Address - Zip Code:43009-9616
Mailing Address - Country:US
Mailing Address - Phone:937-561-0899
Mailing Address - Fax:
Practice Address - Street 1:1791 MADDEN RD
Practice Address - Street 2:
Practice Address - City:CABLE
Practice Address - State:OH
Practice Address - Zip Code:43009-9616
Practice Address - Country:US
Practice Address - Phone:937-561-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program