Individual
PATRICIA BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 W WALNUT ST, OGLESBY, IL 61348-1400
(815) 883-3588
Mailing address
520 W WALNUT ST, OGLESBY, IL 61348-1400
(815) 883-3588
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005712
IL
Other
Enumeration date
10/30/2015
Last updated
01/26/2017
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