Individual
TRACY ELIZABETH BLANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1007 LINCOLNWAY, LA PORTE, IN 46350-3201
(219) 325-5474
(219) 325-5456
Mailing address
1007 LINCOLNWAY, LA PORTE, IN 46350-3201
(219) 325-5474
(219) 325-5456
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28118993A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IN
Enumeration date
08/29/2013
Last updated
08/29/2013
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