| Doctor Name: | NADINE BLACKBURN |
| NPI Number: | 1750398335 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 15582 |
| Business Practice Address: | 24281 Postal Ave 211 Moreno Valley, CA - 925533093 |
| Business Phone Number: | 9514889111 |
| Business Fax Number: | 4807738616 |
| Mailing Address: | Po Box 1013, MORENO VALLEY |
| State: | CA |
| Postal Code: | 925561013 |
| Phone Number: | 9514889111 |
| Fax Number: | 4804459790 |
| NPI Enumeration Date: | 08/03/2006 |
| NPI Last Update Date: | 04/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 15582 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |