MRS. Andrea Blackham

NPI #1093161390 in Provo, Utah

Provider Information

NPI Number: 1093161390
Entity Type: Individual
Name: MRS. Andrea Blackham
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Case Manager/Care Coordinator
Enumeration Date: May 5, 2016
Last Updated: Feb 21, 2019

Practice Location

Address: 750 N FREEDOM BLVD
City: Provo
State: Utah
ZIP Code: 84601-1677
Phone: (801) 373-4760

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Manager/Care Coordinator	171M00000X	Primary
Student in an Organized Health Care Education/Training Program	390200000X

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