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Individual

TRACEY BLANCHARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
5911 NORTHWEST HWY STE 207, CRYSTAL LAKE, IL 60014-8043
(815) 526-3781
Mailing address
5911 NORTHWEST HWY STE 207, CRYSTAL LAKE, IL 60014-8043
(815) 526-3781

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043118421
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
043118421
LICENSED PRACTICAL NURSE
IL
Enumeration date
05/17/2018
Last updated
05/17/2018
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