Healthcare Provider Details

I. General information

NPI: 1063965879
Provider Name (Legal Business Name): JAMI J BLACKBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 FORT AMANDA RD
LIMA OH
45805-4805
US

IV. Provider business mailing address

2745 FORT AMANDA RD
LIMA OH
45805-4805
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5700
  • Fax:
Mailing address:
  • Phone: 419-996-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: