Individual
MRS. MAGEN MORINE BLADES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1242 E. INDEPENDENCE, SUITE 200, SPRINGFIELD, MO 65804
(417) 883-5500
(417) 883-5577
Mailing address
1242 E. INDEPENDENCE, SUITE 200, SPRINGFIELD, MO 65804
(417) 883-5500
(417) 883-5577
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2008009941
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811162852
TRICARE
MO
01
—
P00957131
PALMETTO GBA RAILROAD
MO
Enumeration date
04/29/2008
Last updated
12/29/2016
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