Individual
NANCY MARIE BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2560 BUSINESS PARK DR NE, CLEVELAND, TN 37311-6503
(423) 472-5401
(423) 479-3060
Mailing address
2560 BUSINESS PARK DR NE, CLEVELAND, TN 37311-6503
(423) 472-5401
(423) 479-3060
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD0000015363
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30092801
MEDICARE ID - PTAN
TN
05
—
3009288
—
TN
Enumeration date
06/14/2005
Last updated
11/30/2010
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