Provider Demographics
NPI:1366107328
Name:BLANTON, JAMI LEE (LPN)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:LEE
Last Name:BLANTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JAMI
Other - Middle Name:L
Other - Last Name:BLANTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE
Mailing Address - Street 1:11050 PRESBYTERIAN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-2982
Mailing Address - Country:US
Mailing Address - Phone:317-823-6841
Mailing Address - Fax:317-826-2038
Practice Address - Street 1:11050 PRESBYTERIAN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-2982
Practice Address - Country:US
Practice Address - Phone:317-823-6841
Practice Address - Fax:317-826-2038
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27047923A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse