Individual
BART L BLAYLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
15810 N 28TH AVE, PHOENIX, AZ 85053-4074
(480) 758-8626
Mailing address
15810 N 28TH AVE, PHOENIX, AZ 85053-4074
(807) 588-6264
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
RN144618
AZ
163WC0400X
Case Management Registered Nurse
RN144618
AZ
Other
Enumeration date
07/04/2023
Last updated
07/04/2023
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