Provider Demographics
NPI:1679222103
Name:BLANKENSHIP, SAMANTHA FRANCES
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:FRANCES
Last Name:BLANKENSHIP
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 1:318 LAWSON LN
Mailing Address - Street 2:
Mailing Address - City:LYBURN
Mailing Address - State:WV
Mailing Address - Zip Code:25632-9743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:318 LAWSON LN
Practice Address - Street 2:
Practice Address - City:LYBURN
Practice Address - State:WV
Practice Address - Zip Code:25632-9743
Practice Address - Country:US
Practice Address - Phone:304-752-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant