Individual
GLADYS BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
285 W 12TH ST STE 206, PERU, IN 46970-1654
(765) 472-5335
Mailing address
285 W 12TH ST STE 206, PERU, IN 46970-1654
(765) 472-5335
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28222639A
IN
363LF0000X
Family Nurse Practitioner
Primary
71010379A
IN
Other
Enumeration date
08/24/2020
Last updated
02/28/2025
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