Individual
NANCY A BLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3105 CLEARWATER DR STE A, PRESCOTT, AZ 86305-7166
(928) 717-1600
Mailing address
3105 CLEARWATER DR STE A, PRESCOTT, AZ 86305-7166
(928) 717-1600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4146
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
918401
—
AZ
01
—
AZ0769710
BCBS PROV NUMBER
AZ
Enumeration date
08/31/2006
Last updated
07/08/2007
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