Provider Demographics
NPI:1013159946
Name:BLANCHARD, ELIZABETH MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:225 SUPERCHARGE DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6136
Mailing Address - Country:US
Mailing Address - Phone:985-446-8441
Mailing Address - Fax:
Practice Address - Street 1:157 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2761
Practice Address - Country:US
Practice Address - Phone:985-537-2638
Practice Address - Fax:985-537-2639
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA100313163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse