Individual
MARK N BLANKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
3400 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-5127
(215) 590-1000
Mailing address
3400 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-5127
(215) 590-1000
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
SP023534
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NPPA045761
PRESCRIPTIVE AUTHORITY - PENNSYLVANIA STATE BOARD OF NURSING
PA
01
—
SP023534
CERTIFIED REGISTERED NURSE PRACTITIONER - PENNSYLVANIA STATE BOARD OF NURSING
PA
Enumeration date
07/06/2021
Last updated
07/06/2021
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