Basic Information
| Provider Information | |||||||||
| NPI: | 1871131169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLANKESHIP | ||||||||
| FirstName: | HANNAH | ||||||||
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| Credential: | LPN.171264.MEDS-IV | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 MARION PIKE STE 3 | ||||||||
| Address2: | |||||||||
| City: | COAL GROVE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456382958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406466640 | ||||||||
| FaxNumber: | 7404765226 | ||||||||
| Practice Location | |||||||||
| Address1: | 323 MARION PIKE STE 3 | ||||||||
| Address2: | |||||||||
| City: | COAL GROVE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456382958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406466640 | ||||||||
| FaxNumber: | 7404765226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2019 | ||||||||
| LastUpdateDate: | 05/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | CDCA172482 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 164W00000X | LPN.171264.MEDS-IV | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | 0383244 | 05 | OH | MEDICAID |