Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA59595 | FL |
NPI | 1831406644 |
---|---|
Provider Name | Mrs. Crystal Lynn Blankenship |
First Address | Fort Meade, FL 33841-9534 |
Second Address | Avon Park, FL 33825-8343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2010 |
Last Update Date | 01/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA 59550 | MASSAGE STATE ID (01) | FL |