Provider Information for 1417022468
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
SHAWN THORNTON BLAKLEY MSE, CADCIII
Sex: Male
NPI: 1417022468
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1417022468 | ||||||||||||
| Enumeration Date | 2006-11-22 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 130 E WALNUT ST SUITE 706 GREEN BAY, WI 54301-4239 United States Phone: 920-437-8256 | Fax:920-437-1188 | ||||||||||||
| Primary Practice Address | 130 E WALNUT ST SUITE 706 GREEN BAY, WI 54301-4239 United States Phone: 920-437-8256 | Fax:920-437-1188 | ||||||||||||
| Secondary Practice Address(es) | |||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|