Carissa Fawn Blank, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

201393726LPN Issued in OR

Practice address

151 W 7TH Ave
Suite 100
Eugene, OR 97401-1100

Phone

(541) 682-8779

Fax

(541) 682-9924

NPI assigned

Nov 4, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Carissa Fawn Webb Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: carissa.blank.p2@direct.lanecounty.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430352000000",
    "number": "1114356714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25110 PERKINS RD",
            "city": "VENETA",
            "state": "OR",
            "postal_code": "974879756",
            "telephone_number": "541-505-0498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 W 7TH AVE",
            "address_2": "SUITE 100",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974011100",
            "telephone_number": "541-682-8779",
            "fax_number": "541-682-9924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANK",
        "first_name": "CARISSA",
        "middle_name": "FAWN",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-04",
        "last_updated": "2015-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OR",
            "license": "201393726LPN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARISSA",
            "last_name": "WEBB",
            "middle_name": "FAWN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Blaker Enterprises Inc
• Debra Susan Blaker, FNP
• Sagamore James Blakley, PSS
• Quinn Blanchard, PT, DPT
• Martha Blanchet, L.M.T., M.A., C.H.P.
• Shannon N Blanken, RPH
• Lindsay Stuve Blankenship
• Dylan Blanks, RN
• Jonell Blase, NP
• Daniel Blasher

• Licensed Practical Nurse in Eugene, OR
• Providers in Eugene, OR by specialty
• Licensed Practical Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.