Individual
MRS. ANN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CEDRD, RD, LD
Contact information
Practice address
226 WHITEOAK AVE, RALEIGH, MS 39153-6082
(601) 782-9919
(601) 782-9920
Mailing address
226 WHITEOAK AVE, RALEIGH, MS 39153-6082
(601) 782-9919
(601) 782-9920
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D0705
MS
Other
Enumeration date
11/28/2012
Last updated
11/28/2012
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