Provider Demographics
NPI:1295169316
Name:BLANKEN, TRICIA LYNN (RN)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:LYNN
Last Name:BLANKEN
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 1:1506 BAIR RD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9461
Mailing Address - Country:US
Mailing Address - Phone:937-408-7025
Mailing Address - Fax:
Practice Address - Street 1:1506 BAIR RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9461
Practice Address - Country:US
Practice Address - Phone:937-408-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH289595163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse