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General NPI Number Information
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NPI Number | 1811235328
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Entity Type | Individual
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Provider Name | ANN ELIZABETH BLACKWELL R.N,
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Gender | Female
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 505 W SAN JUAN DR
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City | BLOOMINGTON
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State | IN
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Zip | 47403-4385
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Country | US
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Telephone | 812-320-1852
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Fax |
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Provider Business Mailing Address
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Address Line | 505 W SAN JUAN DR APT/SUITE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-4385
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Country | US
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Telephone | 812-320-1852
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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 | 163WM0102X
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Taxonomy Name | Maternal Newborn Registered Nurse
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License Number | 28158668A
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License Number State | IN
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