MEDICARE: NELLIE ANN BLUNT PA-C

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	363A00000X	Physician Assistant	PA17354	CA

General Provider Information

NPI Number	:	1982961702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELLIE ANN BLUNT PA-C

Provider Business Mailing Address
First Line	:	27067 SUNNINGDALE WAY
Second Line	:
City	:	VALLEY CENTER
State	:	CA
Zip	:	92082-6642
Country	:	US
Telephone Number	:	760-525-4475
Fax Number	:	760-751-4215

Provider Business Practice Location Address
First Line	:	6250 EL CAMINO REAL
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1603
Country	:	US
Telephone Number	:	760-603-8801
Fax Number	:	760-931-3126

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

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	04/18/2012

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Directions to “ NELLIE ANN BLUNT PA-C” Practice Location

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