Individual
MRS. VIVIAN H BLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
914 N DIXIE AVE, SUITE 306, ELIZABETHTOWN, KY 42701-2537
(270) 769-1559
(270) 234-9152
Mailing address
914 N DIXIE AVE, SUITE 306, ELIZABETHTOWN, KY 42701-2537
(270) 769-1559
(270) 234-9152
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
17393
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062513
ANTHEM PROVIDER
KY
05
—
64173933
—
KY
Enumeration date
09/30/2005
Last updated
05/02/2018
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