Mary Clare Blackburn, RN CDE

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

073470 Issued in MO

Practice address

851 E 5TH St
Suite 154
Washington, MO 63090-3135

Phone

(636) 239-8248

NPI assigned

Mar 16, 2010

Last updated

Mar 16, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268697600000",
    "number": "1003130360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 E 5TH ST",
            "address_2": "SUITE 154",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630903135",
            "telephone_number": "636-239-8248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 E 5TH ST",
            "address_2": "SUITE 154",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630903135",
            "telephone_number": "636-239-8248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "MARY",
        "middle_name": "CLARE",
        "credential": "RN  CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-16",
        "last_updated": "2010-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "MO",
            "license": "073470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beyond the Horizon ABA
• Rajasekhar Reddy Bhoda, M.D
• Jennifer Biermann, PHARM.D.
• Kevin Michael Biermann, O.D.
• Amanda Jessie Bissell, O.D.
• Kristen C Blakeman, OT
• Ashley Ann Blanchard, AG-ACNP-BC
• Christina Marie Blankenship, NP
• Carl F Blatt Jr., M.D.
• Christy R Bleckman, M.D.

• Diabetes Educator Registered Nurse in Washington, MO
• Providers in Washington, MO by specialty
• Diabetes Educator Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.