| NPI | 1376786343 |
|---|---|
| Professional Name | MARIAH JENTIEL BLAECKBOURN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH NP 10470) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2022-07-21 |