Provider Demographics
NPI:1972278364
Name:BLOUNT, CONNIE (CD(DONA))
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 GARDEN CITY RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-9159
Mailing Address - Country:US
Mailing Address - Phone:757-318-0597
Mailing Address - Fax:
Practice Address - Street 1:6270 GARDEN CITY RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-9159
Practice Address - Country:US
Practice Address - Phone:757-318-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula