Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 0101243337 | VA |
N | 207PE0004X | Emergency Medical Services | 4301081907 | MI |
NPI | 1104845809 |
---|---|
Provider Name | Darrielle Valerie Blum |
First Address | Richmond, VA 23225-4017 |
Second Address | Richmond, VA 23225-4017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 11/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022923V20 | MEDICARE PROVIDER NUMBER (01) | VA |
1104845809 | (05) | VA |