Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW404 | FL |
NPI | 1013595503 |
---|---|
Provider Name | Ms. Rosalie Delaney Blackwell |
First Address | Live Oak, FL 32064-4421 |
Second Address | Live Oak, FL 32064-4421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2021 |
Last Update Date | 07/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MW404 | STATE LICENSE NUMBER (01) | FL |