Individual
TAMMI ENDICOTT BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
20 HOSPITAL DR, LOGAN, WV 25601-3452
(304) 831-1643
Mailing address
PO BOX 708760, SANDY, UT 84070-8760
(801) 352-9500
(801) 352-7976
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
54203
WV
Other
Enumeration date
05/09/2018
Last updated
05/09/2018
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