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General NPI Number Information
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NPI Number | 1457892853
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Entity Type | Individual
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Provider Name | ANGELA BLACKBURN NP
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Gender | Female
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Dates
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Enumeration Date | 03/17/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 31208 DAY LILY DR
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City | BROWNSTOWN
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State | MI
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Zip | 48173-8768
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Country | US
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Telephone | 734-358-0436
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Fax |
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Provider Business Mailing Address
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Address Line | 31208 DAYLILLY DR
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City | BROWNSTOWN
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State | MI
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Zip | 48173
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Country | US
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Telephone | 734-358-0436
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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 | 44704205566
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License Number State | MI
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