Individual
MR. STEVE L BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHA, MPAS, PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3230-023
WI
363AS0400X
Surgical Physician Assistant
Primary
3230-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487084422
—
WI
Enumeration date
11/12/2013
Last updated
08/15/2016
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