Organization Name: | EXPRESS CARE CLINIC L.L.C. |
NPI Number: | 1114139722 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARGARET ANN BLACKBURN (CFNP) |
Mailing Address: | 1455 Robert C Byrd Dr Crab Orchard |
State: | WV US |
Postal Code: | 258279441 |
Phone Number: | 3042555533 |
Fax Number: | 3049295533 |
NPI Enumeration Date: | 05/04/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2100X |
License Number: | 48923 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Acute Care |
Taxonomy Definition: |