Connie M Blackmore, RN
Individual provider Active NPI General Practice Registered Nurse · Aptos, CA
NPI 1548469588 · NPPES record last updated Jul 11, 2007
Key facts
- NPI
- 1548469588
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Registered Nurse 163WG0000X
- License
- 513345 (CA)
- Practice address
- 3155 Corte Cabrillo Drive
Aptos, CA 95003 - Phone
- (831) 465-1421
- NPI assigned
- Jul 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 513345 | CA | MD | General Practice Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 513345 | CA | Yes |
Addresses
Primary practice location
3155 Corte Cabrillo Drive
Aptos, CA 95003
Mailing address
PO Box 523
Soquel, CA 95073-0523
Phone (831) 475-5853
Other providers in Aptos, CA
- Janyce Ruthann Berg
- Alexandria Bernard
- Amy Bernardi
- Hilary Kline Beymer
- Birth Belly
- Benjamin M Blanchette
- Sally Ann Blumenthal-McGannon
- Devon Paige Bodeson
- Maria Bonsall
- Sarah Spencer Boone
All providers in Aptos, CA · General Practice Registered Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2007. 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.