Individual
MR. JOHN STEPHEN BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
7210G BROAD RIVER RD, IRMO, SC 29063-7972
(803) 407-5266
Mailing address
PO BOX 1637, IRMO, SC 29063-1637
(803) 407-5266
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
11770
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11770
APN
TN
01
—
60552
RN
TN
Enumeration date
03/09/2006
Last updated
07/08/2007
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