NPI | 1649775131 |
---|---|
Former Name | BONNIE LYNN BLACKBURN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX T5832) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2018-03-27 |
Last Update Date | 2024-10-02 |