Provider Demographics
NPI:1063084754
Name:BLANK, MARIA (CNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BLANK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 PEPPER BERRY LN
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1956
Mailing Address - Country:US
Mailing Address - Phone:614-493-8694
Mailing Address - Fax:
Practice Address - Street 1:4505 PEPPER BERRY LN
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1956
Practice Address - Country:US
Practice Address - Phone:614-493-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily