Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP125776 | MO |
NPI | 1023394152 |
---|---|
Provider Name | Michael James Blew |
First Address | Columbia, SC 29203 |
Second Address | Columbia, SC 29204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2011 |
Last Update Date | 28/02/2020 |