| NPI | 1336484286 |
|---|---|
| Former Name | NICOLE BLACKBURN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7518925-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 7518925-8900) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT F0912023) | |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2025-09-26 |