Healthcare Provider Details

I. General information

NPI: 1427497387
Provider Name (Legal Business Name): MARTHA MARIE BLUHM RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8632 CASTLEBAY DR
CHARLOTTE NC
28277-1861
US

IV. Provider business mailing address

8632 CASTLEBAY DR
CHARLOTTE NC
28277-1861
US

V. Phone/Fax

Practice location:
  • Phone: 980-226-5099
  • Fax: 980-226-5099
Mailing address:
  • Phone: 980-226-5099
  • Fax: 980-226-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number187117
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: