Individual
MS. DENISE P BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Contact information
Practice address
1011 BOWLES AVE, SUITE G10, FENTON, MO 63026-2395
(314) 965-9980
(314) 965-1127
Mailing address
2124 MARTINA DR, WASHINGTON, MO 63090-5213
(636) 259-0207
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
125820
MO
363LF0000X
Family Nurse Practitioner
Primary
2012021023
MO
Other
Enumeration date
08/20/2012
Last updated
08/20/2012
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