Individual
LUE BLAYLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10908 BRIAROAKS DR, FORT WORTH, TX 76140-5578
(817) 966-5226
Mailing address
10908 BRIAROAKS DR, FORT WORTH, TX 76140-5578
(817) 966-5226
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
567933
TX
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
L-10590
TX
Other
Enumeration date
04/14/2017
Last updated
04/14/2017
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