Provider Demographics
NPI:1336758606
Name:BLAND, THELMA
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:
Last Name:BLAND
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:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26349-0025
Mailing Address - Country:US
Mailing Address - Phone:304-739-2633
Mailing Address - Fax:
Practice Address - Street 1:147 SAMARITAN CIR
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-8138
Practice Address - Country:US
Practice Address - Phone:304-739-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant