Individual
BRENDA BLACKISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
401 WINSTON AVE, WILMINGTON, DE 19804-1818
(302) 290-5390
(302) 993-1029
Mailing address
101 CHESAPEAKE BLVD STE B, ELKTON, MD 21921-6607
(903) 948-8566
(302) 633-5844
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
LG-0000930
DE
363LF0000X
Family Nurse Practitioner
Primary
LG-0000930
DE
Other
Enumeration date
05/05/2016
Last updated
06/20/2024
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