Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024168992 | VA |
NPI | 1003120486 |
---|---|
Provider Name | Selena Marsette Blankenship |
First Address | Lynchburg, VA 24504-2306 |
Second Address | Lynchburg, VA 24504-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2010 |
Last Update Date | 21/09/2010 |