Individual
MRS. ELAINE MARIE BLANK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
7410 BOTTING RD, RACINE, WI 53402-9742
(126) 268-1303
Mailing address
7410 BOTTING RD, RACINE, WI 53402-9742
(126) 268-1303
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
17951-031
WI
Other
Enumeration date
03/16/2006
Last updated
07/08/2007
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