NPI 1114236429

Anna L Blackford

Practitioner Private Vehicle Sagle, ID

Practice location

Address: 455 39 G Rd, Sagle, ID 83860-8960
Phone: (208) 290-1079
Mailing address: PO Box 573, Ponderay, ID 83852-0573

Registered specialties

Private Vehicle Primary

Transportation Services Taxonomy 347C00000X Licence QK307464B (ID)

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Registry record

NPI: 1114236429
Entity type: Individual
Sex (as registered): Female
NPI issued: 4 Oct 2010
Record last updated: 4 Oct 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.