Individual
CHARLES DEAN BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
1001 CARDWELL ST, SAINT CLAIR, MO 63077-1094
(636) 629-3300
(636) 629-7377
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(314) 364-7586
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2016019132
MO
363LF0000X
Family Nurse Practitioner
Primary
71006846A
IN
Other
Enumeration date
06/23/2016
Last updated
09/25/2024
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