Provider Demographics
NPI:1184985335
Name:BLANKS, SHEILA LANE (FNP)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:LANE
Last Name:BLANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:MICHELE
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 986513
Mailing Address - Street 2:DEPT 100
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6513
Mailing Address - Country:US
Mailing Address - Phone:910-219-8326
Mailing Address - Fax:910-939-4269
Practice Address - Street 1:156 MEMORIAL CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6322
Practice Address - Country:US
Practice Address - Phone:910-353-0680
Practice Address - Fax:910-353-3629
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily