Provider Demographics
NPI:1780839860
Name:BLAINE, MARIAN J (RN)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:J
Last Name:BLAINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 APPLE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-4504
Mailing Address - Country:US
Mailing Address - Phone:419-517-4171
Mailing Address - Fax:419-517-4172
Practice Address - Street 1:5951 APPLE MEADOW DR
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-4504
Practice Address - Country:US
Practice Address - Phone:419-517-4171
Practice Address - Fax:419-517-4172
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 151175163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse