Healthcare Provider Details

I. General information

NPI: 1679684450
Provider Name (Legal Business Name): ALEXIS MALPICA BLOUNT RN, APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE PEDIATRIC SPECIALTY CLINIC AMERICA BUILDING
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

602 E MAPLE RD
LINTHICUM MD
21090-2621
US

V. Phone/Fax

Practice location:
  • Phone: 301-400-1657
  • Fax: 301-295-5069
Mailing address:
  • Phone: 410-684-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF333766-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR162506
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: