Individual
ANDREA MECHELLE WASHINGTON BLACKSHEAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10172 DEER GLEN TRL, FORT WORTH, TX 76140-6521
(817) 999-3957
Mailing address
10172 DEER GLEN TRL, FORT WORTH, TX 76140-6521
(817) 999-3957
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
313070
TX
Other
Enumeration date
07/16/2024
Last updated
07/16/2024
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