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1114356714
CARISSA FAWN BLANK
EUGENE, OR
NPI
1114356714
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Former Name
CARISSA FAWN WEBB
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
164W00000X Licensed Practical Nurse
(Licence: OR 201393726LPN)
Enumeration Date
2013-11-04
Last Update Date
2015-04-30
Business Address
-- CARISSA FAWN BLANK LPN
151 W 7TH AVE SUITE 100
EUGENE, OR 97401-1100
Phone number: 541-682-8779
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Mailing Address
-- CARISSA FAWN BLANK LPN
25110 PERKINS RD
VENETA, OR 97487-9756
Phone number: 541-505-0498
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