Provider Demographics
NPI:1659414811
Name:BLANKENSHIP, MARILYN YVETTE (RN, BSN, SF)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:YVETTE
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:RN, BSN, SF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 GRAND VIEW CT
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24280-3510
Mailing Address - Country:US
Mailing Address - Phone:276-971-6522
Mailing Address - Fax:276-880-1238
Practice Address - Street 1:4119 GRAND VIEW CT
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:VA
Practice Address - Zip Code:24280-3510
Practice Address - Country:US
Practice Address - Phone:276-971-6522
Practice Address - Fax:276-880-1238
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities