Individual
MS. ANNIE DELORES BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
117 E KINGS HWY, EDEN, NC 27288-5201
(336) 623-9711
Mailing address
117 E KINGS HWY, EDEN, NC 27288-5201
(336) 623-9711
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024165671
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
072294
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051039
—
NC
Enumeration date
01/25/2007
Last updated
09/14/2015
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