Individual
MELISSA FAWN BLANKENSHIP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(855) 446-5937
(740) 376-1940
Mailing address
PO BOX 449, MARIETTA, OH 45750-0449
(740) 374-4500
(740) 374-5887
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.339875
OH
367500000X
Certified Registered Nurse Anesthetist
APRN.CRNA.10400
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN46602
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000593388
ANTHEM
OH
01
—
000000642757
ANTHEM
OH
05
—
2890760
—
OH
05
—
3810013880
—
WV
Enumeration date
11/11/2008
Last updated
12/03/2019
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