| NPI | 1568718336 |
|---|---|
| Former Name | NANCI SULLIVAN BLACKERT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005832) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC F0512372) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2016-08-11 |