Individual
RASHIDA BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1334 S 4TH ST, PHILADELPHIA, PA 19147-5933
(267) 474-1405
Mailing address
1334 S 4TH ST, PHILADELPHIA, PA 19147-5933
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN292106
PA
Other
Enumeration date
03/13/2020
Last updated
05/05/2020
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