Individual
MS. KATHERINE ANN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1209 10TH ST, PORT HURON, MI 48060-5262
(810) 985-8170
Mailing address
1209 10TH ST, SUITE D, PORT HURON, MI 48060-5262
(810) 898-5817
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700H231390
BCBS GROUP
MI
Enumeration date
01/06/2012
Last updated
12/19/2016
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