NPI | 1497001721 |
---|---|
Former Name | BILLIE CAROL BLACKBURN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA 173529) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN 173529) |
363LF0000X Nurse Practitioner, Family (Licence: SC 18651) | |
Enumeration Date | 2012-07-24 |
Last Update Date | 2024-05-13 |