Individual
MELODY BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
157 N MAIN ST STE A, 157 NORTH MAIN STREET, SUITE A, SUFFOLK, VA 23434-4565
(757) 925-4807
Mailing address
157 N MAIN ST STE A, MAIN STREET PHYSICIANS, SUFFOLK, VA 23434-4565
(757) 925-4807
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024172903
VA
Other
Enumeration date
10/26/2015
Last updated
12/11/2015
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