Erica Lee Blankenship, LPN BM

Individual provider Active NPI Licensed Practical Nurse · Du Quoin, IL

NPI 1649526609 · NPPES record last updated Jul 27, 2012

Key facts

NPI
1649526609
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
043084772 (IL)
Practice address
119 Gas Plant Rd
Du Quoin, IL 62832-3866
Phone
(618) 542-8702
NPI assigned
Jul 27, 2012
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
043084772ILMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 043084772 IL Yes

Addresses

Primary practice location

119 Gas Plant Rd
Du Quoin, IL 62832-3866

Mailing address

PO Box 155
Christopher, IL 62822-0155
Phone (618) 724-2436

Other names

  • Erica Lee Reid Former name

Other providers in Du Quoin, IL

All providers in Du Quoin, IL · Licensed Practical Nurse in Illinois

Sources for this page

Verify at the official NPI Registry.