Provider Demographics
NPI:1194334144
Name:BLANCHARD, SONJI M
Entity type:Individual
Prefix:
First Name:SONJI
Middle Name:M
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8553 N BEACH ST STE 224
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4919
Mailing Address - Country:US
Mailing Address - Phone:817-701-8283
Mailing Address - Fax:
Practice Address - Street 1:8553 N BEACH ST STE 224
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4919
Practice Address - Country:US
Practice Address - Phone:817-701-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory