Provider Demographics
NPI:1275736621
Name:BLOUNT, MARSHALL LEWIS V (FNP PRACTITONER)
Entity type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:LEWIS
Last Name:BLOUNT
Suffix:V
Gender:M
Credentials:FNP PRACTITONER
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2261 VALENTANO DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3312
Mailing Address - Country:US
Mailing Address - Phone:408-230-1348
Mailing Address - Fax:
Practice Address - Street 1:2238 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3416
Practice Address - Country:US
Practice Address - Phone:415-833-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
171M00000X
CANP95030340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator