Provider Demographics
NPI:1083091656
Name:BLOWE, MICHON
Entity Type:Individual
Prefix:
First Name:MICHON
Middle Name:
Last Name:BLOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19711 ENGLISH WELLS WAY APT 202
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7877
Mailing Address - Country:US
Mailing Address - Phone:804-735-8477
Mailing Address - Fax:
Practice Address - Street 1:4914 FITZHUGH AVE STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3534
Practice Address - Country:US
Practice Address - Phone:804-213-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189247363LP0808X
VA0001209359163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health