Provider Demographics
NPI:1538953534
Name:BLACKWELL, MARINA NICHOLE (DPM)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:NICHOLE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 S SOUTHERN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8000
Mailing Address - Country:US
Mailing Address - Phone:812-340-2738
Mailing Address - Fax:
Practice Address - Street 1:4700 E GALBRAITH RD STE 205
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3557
Practice Address - Country:US
Practice Address - Phone:513-853-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program