Individual
MALLORY C BLANKENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5165 MCCARTY LANE, LAFAYETTE, IN 47905-8764
(800) 899-8448
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002240A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300018177
—
IN
Enumeration date
07/12/2017
Last updated
05/15/2025
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