Individual
PAULINE BLACKSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LE
Contact information
Practice address
9418 W LAKE MEAD BLVD, LAS VEGAS, NV 89134-8312
(702) 400-3119
Mailing address
9418 W LAKE MEAD BLVD, LAS VEGAS, NV 89134-8312
(702) 400-3119
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E-54643
NV
Other
Enumeration date
01/06/2025
Last updated
01/06/2025
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