Individual
MS. LISA VICTORIA BLACKWELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
924 AUDRA ST, CEDAR PARK, TX 78613-7102
(512) 426-8589
Mailing address
924 AUDRA ST, CEDAR PARK, TX 78613-7102
(512) 426-8589
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
593651
TX
Other
Enumeration date
02/01/2019
Last updated
02/01/2019
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