Individual
BLAIR BLACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CPNP
Contact information
Practice address
3500 GASTON AVE, DALLAS, TX 75246-2017
(214) 820-0111
Mailing address
4105 VALLEY VIEW RD UNIT A, AUSTIN, TX 78704-7994
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
778669
TX
Other
Enumeration date
11/01/2013
Last updated
11/01/2013
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