Individual
ELIZABETH BOLES BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-8759
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-8759
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1000477
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190684
MEDCOST
—
01
—
7254848
AETNA
—
01
—
P00397963
RR MEDICARE
—
Enumeration date
07/30/2006
Last updated
11/15/2010
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