Provider Demographics
NPI:1013653435
Name:BLANCHARD-POLLOCK, MILDRED (LVN)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:BLANCHARD-POLLOCK
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7032 TUTHER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-5941
Mailing Address - Country:US
Mailing Address - Phone:619-395-8302
Mailing Address - Fax:
Practice Address - Street 1:7032 TUTHER WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-5941
Practice Address - Country:US
Practice Address - Phone:619-395-8302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA682866164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse