Healthcare Provider Details

I. General information

NPI: 1871031260
Provider Name (Legal Business Name): ANNA KD BLUM PMHCNS-BC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ORANGE ST
CHARLOTTESVILLE VA
22902-4859
US

IV. Provider business mailing address

401 ORANGE ST
CHARLOTTESVILLE VA
22902-4859
US

V. Phone/Fax

Practice location:
  • Phone: 434-987-1818
  • Fax:
Mailing address:
  • Phone: 434-987-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0015070939
License Number StateVA

VIII. Authorized Official

Name: MS. ANNA KD BLUM
Title or Position: OWNER
Credential: PMHCNS-BC
Phone: 434-987-1818