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General NPI Number Information
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NPI Number | 1174344683
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Entity Type | Individual
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Provider Name | ANGIE MARRIE BLUNK ND
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 1177 E BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40204-1711
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Country | US
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Telephone | 502-938-7685
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Fax |
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Provider Business Mailing Address
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Address Line | 4912 OLD FOREST RD SW
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City | CORYDON
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State | IN
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Zip | 47112-6440
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Country | US
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Telephone | 502-938-7685
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 0
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License Number State | KY
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