Individual
CARISSA FAWN BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
151 W 7TH AVE, SUITE 100, EUGENE, OR 97401-1100
(541) 682-8779
(541) 682-9924
Mailing address
25110 PERKINS RD, VENETA, OR 97487-9756
(541) 505-0498
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201393726LPN
OR
Other
Enumeration date
11/04/2013
Last updated
04/30/2015
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