Individual
MARY L BLANKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1 SHAWS CV, NEW LONDON, CT 06320-4902
(860) 447-8304
(860) 443-8720
Mailing address
575 MAIN ST FL 2, ATTN: CREDENTIALING DEPARTMENT, MIDDLETOWN, CT 06457-2845
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
003321
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008011052
—
CT
Enumeration date
12/06/2005
Last updated
11/29/2013
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