Individual
DEVON M BLACKBURN
Active
Individual
DEVON M BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71005960A
IN
363LG0600X
Gerontology Nurse Practitioner
71005960A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000979003
ANTHEM PTAN
IN
05
—
201336430
—
IN
Enumeration date
12/10/2015
Last updated
02/10/2025
Update your record
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