Individual
CAROLYN BLANC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
520 W 3RD ST, KIMBERLY, WI 54136-1300
(920) 788-7680
(920) 788-7688
Mailing address
520 W 3RD ST, KIMBERLY, WI 54136-1300
(920) 788-7680
(920) 788-7688
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
40082
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005945003
MEDICARE PTAN
WI
05
—
3256100
—
WI
Enumeration date
06/23/2006
Last updated
08/24/2021
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