Most Relevant Information
Provider Data
| NPI Number: | 1003554494 |
| Provider Name: | SCOTT ANTHONY BLACKBURN NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP2300X |
| Specialty: | Nurse Practitioner |
| License Number: | 4704326782 |
Most Important Dates
| Enumeration Date: | 05/25/2022 |
| Last Updated: | 04/12/2024 |
Provider Practice Location
15150 FORT ST
SOUTHGATE
MI
481951302
Practice Location Phone/Fax
| Phone: | 7342824800 |
| Fax: | 7342829302 |
Provider Mailing Location
15150 FORT ST
SOUTHGATE
MI
481951302
Provider Mailing Phone/Fax
| Phone: | 7342824800 |
| Fax: |