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General NPI Number Information
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NPI Number | 1578039798
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Entity Type | Individual
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Provider Name | BLONDENIA LABREW NP
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Gender | Female
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Dates
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Enumeration Date | 10/15/2018
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1023 SILVER BLUFF RD
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City | AIKEN
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State | SC
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Zip | 29803-5879
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Country | US
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Telephone | 803-502-5515
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Fax |
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Provider Business Mailing Address
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Address Line | 1291 CUMMINGS RD
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City | RIDGE SPRING
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State | SC
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Zip | 29129-9651
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Country | US
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Telephone | 803-270-3351
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | RN148963
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN148963
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License Number State | GA
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