Individual
LAURIE JOY BLANCO VALERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
114 N. DIVISION, CAYUGA, IN 47928-8230
(765) 492-9042
(765) 492-9048
Mailing address
PO BOX 344, CLINTON, IN 47842-0344
(765) 828-1003
(765) 828-1030
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11013528A
IN
207V00000X
Obstetrics & Gynecology Physician
01065814A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200954800
—
IN
Enumeration date
08/06/2008
Last updated
06/03/2011
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