Provider Demographics
NPI:1912341496
Name:BLANTON, HEATHER THOMAS (LPN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:THOMAS
Last Name:BLANTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 OLD CONVERSE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-3205
Mailing Address - Country:US
Mailing Address - Phone:864-279-6104
Mailing Address - Fax:864-279-6173
Practice Address - Street 1:1315 OLD CONVERSE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-3205
Practice Address - Country:US
Practice Address - Phone:864-279-6104
Practice Address - Fax:864-279-6173
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29302P164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse