Blankenberger, Mallory C

Blankenberger, Mallory C is an individual health care provider with primary practice located at 5165 Mccarty Lane , Lafayette IN 47905-8764. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Blankenberger, Mallory C can be contacted via phone (800) 899-8448.

Contact Information

Primary practice address
5165 Mccarty Lane Lafayette IN 47905-8764
Phone: (800) 899-8448
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10002240A Indiana

Profile Details

NPI number 1104348044
LBN Legal business name Blankenberger, Mallory C
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2017
Last updated Jul 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104348044 NPPES
Indiana MEDICAID 300018177
Indiana Other 264430D75

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