Provider Demographics
NPI:1780237255
Name:BLANN, JANICE REYBURN (NP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:REYBURN
Last Name:BLANN
Suffix:
Gender:
Credentials:NP
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 3397
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28564-3397
Mailing Address - Country:US
Mailing Address - Phone:276-601-6197
Mailing Address - Fax:276-601-6156
Practice Address - Street 1:PO BOX 3397
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28564-3397
Practice Address - Country:US
Practice Address - Phone:276-601-6197
Practice Address - Fax:276-601-6156
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021894363LG0600X
AZ227742363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ227742OtherARIZONA NURISNG BOARD
AZ561715Medicaid
NC5021894OtherNP