Provider Demographics
NPI:1871337030
Name:WESTBROOK, BLANCA ODILIA (RN-FNP)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:ODILIA
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:RN-FNP
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:O
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN-FNP
Mailing Address - Street 1:435 SHENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1956
Mailing Address - Country:US
Mailing Address - Phone:626-463-3922
Mailing Address - Fax:
Practice Address - Street 1:435 SHENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1956
Practice Address - Country:US
Practice Address - Phone:626-463-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA756823163W00000X
VA0001317217163W00000X
CA95026749363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse