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General NPI Number Information
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NPI Number | 1669994331
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Entity Type | Organization
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Legal Business Name | BLOSSOMWOOD RESEARCH LLC
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2121 WHITESBURG DR SE STE D
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4501
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Country | US
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Telephone | 256-883-0107
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Fax | 256-883-0207
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Provider Business Mailing Address
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Address Line | 2121 WHITESBURG DR SE STE D
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4501
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Country | US
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Telephone | 256-883-0107
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Fax | 256-883-0207
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DZENE JUCEVICIUTE
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Credential |
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Telephone | 256-431-9254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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