Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP30007233 | WA |
NPI | 1053422246 |
---|---|
Provider Name | Ms. Teresa Lynn Blackwell |
First Address | Enumclaw, WA 98022-9135 |
Second Address | Seattle, WA 98105-5653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/06/2016 |