Provider Demographics
NPI:1932215563
Name:BLACKBURN, HELEN
Entity Type:Individual
Prefix:MS
First Name:HELEN
Middle Name:
Last Name:BLACKBURN
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 1:18539 S NC HIGHWAY 109
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27239-7713
Mailing Address - Country:US
Mailing Address - Phone:336-859-5001
Mailing Address - Fax:336-859-1952
Practice Address - Street 1:18539 S NC HIGHWAY 109
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:NC
Practice Address - Zip Code:27239-7713
Practice Address - Country:US
Practice Address - Phone:336-859-5001
Practice Address - Fax:336-859-1952
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC090980363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care