Provider Demographics
NPI:1871030288
Name:BLACKHAM, ALLISON HARTLEY (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:HARTLEY
Last Name:BLACKHAM
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 PLUMAS ST
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4107
Mailing Address - Country:US
Mailing Address - Phone:530-751-2273
Mailing Address - Fax:
Practice Address - Street 1:1003 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4107
Practice Address - Country:US
Practice Address - Phone:530-751-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM479176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife