Provider Demographics
NPI:1760165641
Name:BLANCO, LINDA M (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:BLANCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:51 BRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1825
Mailing Address - Country:US
Mailing Address - Phone:845-548-6741
Mailing Address - Fax:
Practice Address - Street 1:15 SUFFERN PL
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5566
Practice Address - Country:US
Practice Address - Phone:845-357-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329770-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health