Individual
SIMONE BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4870
(714) 655-9299
Mailing address
4224 OTTER STREET, PHILADELPHIA, PA 19104
(714) 655-9299
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
SP032163
PA
Other
Enumeration date
05/06/2026
Last updated
05/06/2026
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