MEDICARE: MRS. KULICIA HUBBARD BLOUNT RN,BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN093955	LA

General Provider Information

NPI Number	:	1316251770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KULICIA HUBBARD BLOUNT RN,BSN

Provider Business Mailing Address
First Line	:	9883 ANDOVER DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2213
Country	:	US
Telephone Number	:	504-416-3054
Fax Number	:	504-242-9905

Provider Business Practice Location Address
First Line	:	9883 ANDOVER DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2213
Country	:	US
Telephone Number	:	504-416-3054
Fax Number	:	504-242-9905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	07/27/2010

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