Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN.CNP.024141 | OH |
NPI | 1003389313 |
---|---|
Provider Name | Janille Ann Blaylock |
First Address | Toledo, OH 43604-7102 |
Second Address | Oregon, OH 43616-3224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2019 |
Last Update Date | 23/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0346545 | (05) | OH |