| NPI | 1740618073 |
|---|---|
| Former Name | DIANA BLACKBURN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109026) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056584) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2018-01-11 |