Provider Demographics
NPI:1750042693
Name:BLANFORD, CHARLOTTE LEE (RN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LEE
Last Name:BLANFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 IRISH BEND CT
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-8802
Mailing Address - Country:US
Mailing Address - Phone:502-314-3460
Mailing Address - Fax:
Practice Address - Street 1:2412 IRISH BEND CT
Practice Address - Street 2:
Practice Address - City:FISHERVILLE
Practice Address - State:KY
Practice Address - Zip Code:40023-8802
Practice Address - Country:US
Practice Address - Phone:502-314-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1059880163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice