Provider Demographics
NPI:1578039798
Name:LABREW, BLONDENIA (NP)
Entity type:Individual
Prefix:MS
First Name:BLONDENIA
Middle Name:
Last Name:LABREW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 CUMMINGS RD
Mailing Address - Street 2:
Mailing Address - City:RIDGE SPRING
Mailing Address - State:SC
Mailing Address - Zip Code:29129-9651
Mailing Address - Country:US
Mailing Address - Phone:803-270-3351
Mailing Address - Fax:
Practice Address - Street 1:1023 SILVER BLUFF RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5879
Practice Address - Country:US
Practice Address - Phone:803-502-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN148963207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty