Provider Demographics
NPI:1942754387
Name:BLANCH, LAURIE LYNN (CPNP)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:LYNN
Last Name:BLANCH
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:275 AXIS CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-2792
Mailing Address - Country:US
Mailing Address - Phone:512-787-7673
Mailing Address - Fax:
Practice Address - Street 1:1400 BROADFIELD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5162
Practice Address - Country:US
Practice Address - Phone:914-919-9200
Practice Address - Fax:833-913-2393
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-14
Last Update Date:2025-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP132192363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics