Tracey Blanchard

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

043118421 Issued in IL

Practice address

5911 Northwest Hwy Ste 207
Crystal Lake, IL 60014-8043

Phone

(815) 526-3781

NPI assigned

May 17, 2018

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1306336144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5911 NORTHWEST HWY STE 207",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148043",
            "telephone_number": "815-526-3781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5911 NORTHWEST HWY STE 207",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148043",
            "telephone_number": "815-526-3781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANCHARD",
        "first_name": "TRACEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-17",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043118421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PRACTICAL NURSE",
            "identifier": "043118421",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ruth A Blameuser, M.S. OT, OTR/L
• Kathi Lyne Bliler, P.A.-C
• Jordan Blochwitz, DMD
• Laura S Blumenkamp, PT
• Tessa Blumthal
• Summer Evalyn Schaal Bochat, DPM

• Licensed Practical Nurse in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.