Provider Demographics
NPI:1053091728
Name:BLATCHFORD, RHIANNON SKYE
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:SKYE
Last Name:BLATCHFORD
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 1:4718 51ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6029
Mailing Address - Country:US
Mailing Address - Phone:701-793-9124
Mailing Address - Fax:
Practice Address - Street 1:1874 17TH AVE N APT 11
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-3165
Practice Address - Country:US
Practice Address - Phone:701-793-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant