Individual
MRS. BRANDY BLACKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
27901 WOODWARD AVE STE 300, BERKLEY, MI 48072-0921
(248) 545-0070
(248) 545-4850
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1865
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601007562
MI
Other
Enumeration date
11/04/2015
Last updated
07/22/2022
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