Emily Blackbourn
Individual provider Active NPI Other Technician · Wayne, MI
NPI 1699179986 · NPPES record last updated Oct 15, 2014
Key facts
- NPI
- 1699179986
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Other Technician 247200000X
- Practice address
- 35640 W Michigan Ave
Wayne, MI 48184-1628 - Phone
- (734) 729-7938
- NPI assigned
- Oct 15, 2014
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | Yes |
Addresses
Primary practice location
35640 W Michigan Ave
Wayne, MI 48184-1628
Mailing address
35640 W Michigan Ave
Wayne, MI 48184-1628
Other providers in Wayne, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2014. 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.