Provider Information for 1528475365
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TAMIKA XENIA BLAISDELL
Sex: Female
NPI: 1528475365
Last Updated: 2023-10-18
Certification Date: 2023-10-12
Certification Date: 2023-10-12
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1528475365 | ||||||||
| Enumeration Date | 2014-07-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 432 E IDAHO ST STE 430 KALISPELL, MT 59901-4137 United States Phone: 406-407-0750 | Fax: | ||||||||
| Primary Practice Address | 9285 LOST PRAIRIE ROAD MARION, MT 59925 United States Phone: 406-407-0750 | Fax: | ||||||||
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