Individual
ALTAGRACE GILBERT BLANCHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
153 LAKE SHORE RD, LAKE RONKONKOMA, NY 11779-3157
(844) 815-1508
Mailing address
120 ELK ST, WYANDANCH, NY 11798-3309
(631) 303-4558
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
33454001
NY
Other
Enumeration date
05/08/2025
Last updated
05/08/2025
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