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NPI Code Detail

MEDICARE: ASHLEY MARIE BLALACK RN

MEDICARE: ASHLEY MARIE BLALACK RN
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
1163WA0400XAddiction (Substance Use Disorder) Registered NurseR105889AR

General Provider Information

NPI Number : 1487452116
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY MARIE BLALACK RN
Provider Business Mailing Address
First Line : 2090 S LYNN RIGGS BLVD APT 37
Second Line :
City : CLAREMORE
State : OK
Zip : 74019-5545
Country : US
Telephone Number : 479-280-8130
Fax Number :
Provider Business Practice Location Address
First Line : 6333 E SKELLY DR
Second Line :
City : TULSA
State : OK
Zip : 74135-6101
Country : US
Telephone Number : 918-779-7117
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2025
Last Update Date : 03/07/2025

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