| Doctor Name: | MARY CLARE BLACKBURN |
| NPI Number: | 1003130360 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN CDE |
| License Number: | 073470 |
| Business Practice Address: | 851 E 5th St Suite 154 Washington, MO - 630903135 |
| Business Phone Number: | 6362398248 |
| Business Fax Number: | |
| Mailing Address: | 851 E 5th St, Suite 154 WASHINGTON |
| State: | MO |
| Postal Code: | 630903135 |
| Phone Number: | 6362398248 |
| Fax Number: | |
| NPI Enumeration Date: | 03/16/2010 |
| NPI Last Update Date: | 03/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | 073470 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |