Provider Demographics
NPI:1982587200
Name:BLANK, DANA (MDN, RDN, LD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BLANK
Suffix:
Gender:F
Credentials:MDN, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 CREEKVIEW LN APT F
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-3606
Mailing Address - Country:US
Mailing Address - Phone:440-384-7559
Mailing Address - Fax:
Practice Address - Street 1:5058 CREEKVIEW LN APT F
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-3606
Practice Address - Country:US
Practice Address - Phone:440-384-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10426133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered