Individual
CHARLOTTE LOUISA BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
W307S7940 APPLEWOOD CT, MUKWONAGO, WI 53149-8833
(414) 828-1259
Mailing address
W307S7940 APPLEWOOD CT, MUKWONAGO, WI 53149-8833
(414) 828-1259
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
312294
WI
Other
Enumeration date
06/22/2017
Last updated
07/21/2022
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