Provider Demographics
NPI:1336937457
Name:BLOUNT, HEATHER (DPA)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:BLOUNT
Suffix:
Gender:
Credentials:DPA
Other - Prefix:
Other - First Name:REV. HEATHER
Other - Middle Name:
Other - Last Name:BLOUNT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FULL SPECTRUM DOULA
Mailing Address - Street 1:301 E 117TH ST APT 4Z
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4947
Mailing Address - Country:US
Mailing Address - Phone:347-998-8773
Mailing Address - Fax:
Practice Address - Street 1:301 E 117TH ST APT 4Z
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4947
Practice Address - Country:US
Practice Address - Phone:347-998-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYASDS1603374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula