Provider Demographics
NPI:1679204630
Name:BLANESS, DEVIN EUGENE
Entity type:Individual
Prefix:MR
First Name:DEVIN
Middle Name:EUGENE
Last Name:BLANESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 POPLAR ST W
Mailing Address - Street 2:
Mailing Address - City:VERNON CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:56090-1119
Mailing Address - Country:US
Mailing Address - Phone:507-508-8834
Mailing Address - Fax:
Practice Address - Street 1:111 BUTTERWORTH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-1108
Practice Address - Country:US
Practice Address - Phone:507-779-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR798105969924172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver