Provider Demographics
NPI:1649526609
Name:BLANKENSHIP, ERICA LEE (LPN BM)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LEE
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LPN BM
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LEE
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN BM
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2436
Mailing Address - Fax:
Practice Address - Street 1:119 GAS PLANT RD
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-3866
Practice Address - Country:US
Practice Address - Phone:618-542-8702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043084772164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse