Provider Demographics
NPI:1578039798
Name:LABREW, BLONDENIA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:BLONDENIA
Middle Name:
Last Name:LABREW
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 CUMMINGS RD
Mailing Address - Street 2:
Mailing Address - City:RIDGE SPRING
Mailing Address - State:SC
Mailing Address - Zip Code:29129-9651
Mailing Address - Country:US
Mailing Address - Phone:803-270-3351
Mailing Address - Fax:
Practice Address - Street 1:2123 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4777
Practice Address - Country:US
Practice Address - Phone:706-736-5244
Practice Address - Fax:706-736-5246
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN148963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty