Individual
SARA AMEND BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1811 E BERT KOUN LOOP STE 400, SHREVEPORT, LA 71105-5764
(318) 212-3810
(318) 212-3815
Mailing address
1811 E BERT KOUN LOOP STE 400, SHREVEPORT, LA 71105-5764
(318) 212-3810
(318) 212-3815
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN134042
LA
363L00000X
Nurse Practitioner
Primary
213810
LA
Other
Enumeration date
05/02/2020
Last updated
06/18/2021
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