Charlotte Louisa Blackburn
Individual provider Active NPI Licensed Practical Nurse · Mukwonago, WI
NPI 1851811533 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1851811533
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 312294 (WI)
- Practice address
- W307S7940 Applewood CT
Mukwonago, WI 53149-8833 - Phone
- (414) 828-1259
- NPI assigned
- Jun 22, 2017
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 312294 | WI | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 312294 | WI | Yes |
Addresses
Primary practice location
W307S7940 Applewood CT
Mukwonago, WI 53149-8833
Mailing address
W307S7940 Applewood CT
Mukwonago, WI 53149-8833
Phone (414) 828-1259
Other providers in Mukwonago, WI
- George A Barsamian
- John Christopher Beauchamp
- Branda Bendixen
- James L. Bialk
- Amanda Erin Binder
- Mitchell Bonjean
- Laura Elizabeth Brandt
- Danielle Brooks
- Cheryl Brown
- Kathryn Brucato
All providers in Mukwonago, WI · Licensed Practical Nurse in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. 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.