Individual
MARYANN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1325 PENNSYLVANIA AVE STE 890, FORT WORTH, TX 76104-2145
(817) 250-7230
Mailing address
3001 GOLDENROD AVE, FORT WORTH, TX 76111-2728
(682) 330-8191
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1092615
TX
Other
Enumeration date
12/28/2022
Last updated
03/13/2023
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