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NPI Code Detail

MEDICARE: MRS. ANNA BLACKWOOD RDH

MEDICARE: MRS. ANNA BLACKWOOD RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist10112KS

General Provider Information

NPI Number : 1184708604
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANNA BLACKWOOD RDH
Provider Business Mailing Address
First Line : PO BOX 557
Second Line :
City : QUINTER
State : KS
Zip : 67752-0557
Country : US
Telephone Number : 785-754-2441
Fax Number :
Provider Business Practice Location Address
First Line : 501 GARFIELD ST
Second Line :
City : QUINTER
State : KS
Zip : 67752-9795
Country : US
Telephone Number : 785-754-2441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 07/08/2007

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