Healthcare Provider Details

I. General information

NPI: 1174344683
Provider Name (Legal Business Name): ANGIE MARRIE BLUNK ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 E BROADWAY
LOUISVILLE KY
40204-1711
US

IV. Provider business mailing address

4912 OLD FOREST RD SW
CORYDON IN
47112-6440
US

V. Phone/Fax

Practice location:
  • Phone: 502-938-7685
  • Fax:
Mailing address:
  • Phone: 502-938-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: