Individual
JESSICA D BLANKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7827 HIGHWAY N STE 104, O FALLON, MO 63368-6704
(636) 377-1177
(636) 377-1911
Mailing address
7827 HIGHWAY N STE 104, O FALLON, MO 63368-6704
(636) 377-1177
(636) 377-1911
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
168548
MO
Other
Enumeration date
09/13/2016
Last updated
09/14/2016
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