Mary Clare Blackburn, RN CDE
Individual provider Active NPI Diabetes Educator Registered Nurse · Washington, MO
NPI 1003130360 · NPPES record last updated Mar 16, 2010
Key facts
- NPI
- 1003130360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diabetes Educator Registered Nurse 163WD0400X
- License
- 073470 (MO)
- Practice address
- 851 E 5TH St
Suite 154
Washington, MO 63090-3135 - Phone
- (636) 239-8248
- NPI assigned
- Mar 16, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 073470 | MO | MD | Diabetes Educator Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diabetes Educator Registered Nurse | 163WD0400X | 073470 | MO | Yes |
Addresses
Primary practice location
851 E 5TH St
Suite 154
Washington, MO 63090-3135
Mailing address
851 E 5TH St
Suite 154
Washington, MO 63090-3135
Phone (636) 239-8248
Other providers in Washington, MO
- Beyond the Horizon ABA
- Rajasekhar Reddy Bhoda
- Jennifer Biermann
- Kevin Michael Biermann
- Amanda Jessie Bissell
- Ashley Ann Blanchard
- Christina Marie Blankenship
- Beth Y Blankley
- Carl F Blatt Jr.
- Christy R Bleckman
All providers in Washington, MO · Diabetes Educator Registered Nurse in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.