Provider Demographics
NPI:1730954116
Name:BLANEY-WILLIAMS, TEDRIENE
Entity type:Individual
Prefix:
First Name:TEDRIENE
Middle Name:
Last Name:BLANEY-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11013 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2781
Mailing Address - Country:US
Mailing Address - Phone:216-376-6455
Mailing Address - Fax:
Practice Address - Street 1:11013 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2781
Practice Address - Country:US
Practice Address - Phone:216-376-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic