Provider Demographics
NPI:1811565716
Name:BLANTON, BRALYNN E
Entity Type:Individual
Prefix:
First Name:BRALYNN
Middle Name:E
Last Name:BLANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1872
Mailing Address - Country:US
Mailing Address - Phone:419-636-7272
Mailing Address - Fax:
Practice Address - Street 1:1009 CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1872
Practice Address - Country:US
Practice Address - Phone:419-636-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide