Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | T-3518 | MS |
Y | 2080P0201X | Pediatric Allergist | 01085977A | IN |
NPI | 1508362328 |
---|---|
Provider Name | Jenyfeer Blanco |
First Address | Indianapolis, IN 46202-5109 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2018 |
Last Update Date | 06/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1508362328 | (05) | MS |