Provider Demographics
NPI:1710458229
Name:BLANKSON, RITA AMA (CNA)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:AMA
Last Name:BLANKSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LADY SLIPPER LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-6404
Mailing Address - Country:US
Mailing Address - Phone:919-949-6599
Mailing Address - Fax:
Practice Address - Street 1:2701 PICKETT RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5688
Practice Address - Country:US
Practice Address - Phone:919-949-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC471736376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide