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Individual

JENNA BLACKWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
230 MITCHELL ST STE B, MILLSBORO, DE 19966-9402
(484) 828-1771
Mailing address
230 MITCHELL ST STE B, MILLSBORO, DE 19966-9402

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
20663601
PA
251J00000X
Nursing Care Agency
04970501
PA
363L00000X
Nurse Practitioner
L8-0010409
DE
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
L8-0010409
DE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
102581115
PA
Enumeration date
12/02/2013
Last updated
06/12/2024
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