Provider Demographics
NPI:1730687641
Name:BLANTON, JOHN ROY (LPN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROY
Last Name:BLANTON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 RUSTADS CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1086
Mailing Address - Country:US
Mailing Address - Phone:757-450-8477
Mailing Address - Fax:
Practice Address - Street 1:701 RUSTADS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1086
Practice Address - Country:US
Practice Address - Phone:757-450-8477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002096163164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse