Provider Demographics
NPI:1174344683
Name:BLUNK, ANGIE MARRIE (ND)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:MARRIE
Last Name:BLUNK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 OLD FOREST RD SW
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-6440
Mailing Address - Country:US
Mailing Address - Phone:502-938-7685
Mailing Address - Fax:
Practice Address - Street 1:1177 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1711
Practice Address - Country:US
Practice Address - Phone:502-938-7685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine