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General NPI Number Information
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NPI Number | 1083315972
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Entity Type | Individual
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Provider Name | MONTRESSA MONIQUE BLOUNT NP
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Gender | Female
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Dates
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Enumeration Date | 03/16/2023
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 3612 POWHATAN RD
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City | CLAYTON
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State | NC
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Zip | 27527-9217
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Country | US
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Telephone | 919-550-2200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 77
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City | WINTERVILLE
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State | NC
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Zip | 28590-0077
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Country | US
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Telephone | 252-341-1638
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5017793
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License Number State | NC
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