| Doctor Name: | MRS. ANGELA BLOTKAMP |
| NPI Number: | 1801122999 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 71003053A |
| Business Practice Address: | 3103 E State Blvd Ft Wayne, IN - 46805 |
| Business Phone Number: | 2603739300 |
| Business Fax Number: | 2603739320 |
| Mailing Address: | 3103 E. State Blvd, FT. WAYNE |
| State: | IN |
| Postal Code: | 46805 |
| Phone Number: | 2603739300 |
| Fax Number: | 2603739320 |
| NPI Enumeration Date: | 10/23/2009 |
| NPI Last Update Date: | 01/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LX0106X |
| License Number: | 71003053A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Occupational Health |
| Taxonomy Definition: | |