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NANCY ANN BLACKETER FNP

>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1518152925

Individual Registrant:
 NANCY ANN BLACKETER FNP
Gender: M
Sole Proprietor

Location and contact information for practice:
3102 EAST HIGHLAND AVE  PATTON, CA 92369 US
Tel: 909-425-7000  Fax: 909-425-7520

Contact information for business:
1600 9TH STREET ROOM 205 MAILSTOP 2-3 SACRAMENTO, CA 95814-6414 US
Tel: 916-654-2431  Fax: 916-654-3186

Registration Information:
NPI: 1518152925
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
CARN11513

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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