Provider Demographics
NPI:1649575333
Name:BLALOCK, MEREDITH WINSLOW (ND)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:WINSLOW
Last Name:BLALOCK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 W HILL ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-8637
Mailing Address - Country:US
Mailing Address - Phone:405-818-0139
Mailing Address - Fax:
Practice Address - Street 1:5009 N PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8887
Practice Address - Country:US
Practice Address - Phone:405-443-0348
Practice Address - Fax:405-843-1494
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60199930175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath