Individual
RYAN MAXWELL BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
U
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(703) 346-9753
Mailing address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/16/2024
Last updated
01/13/2025
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