Provider Demographics
NPI:1659775286
Name:BLANFORD, PAULINE (RN,BSN)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:BLANFORD
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 PROSPERITY RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-8941
Mailing Address - Country:US
Mailing Address - Phone:740-947-2641
Mailing Address - Fax:
Practice Address - Street 1:1 TIGER DR
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-8704
Practice Address - Country:US
Practice Address - Phone:740-947-7701
Practice Address - Fax:740-941-5899
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-170118163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool