Individual
VICTORIA ELISE BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6019 WALNUT GROVE RD, MEMPHIS, TN 38120-2113
(901) 226-5000
Mailing address
33 E NORTHWOOD DR, MEMPHIS, TN 38111-4703
(601) 594-4563
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
904087
MS
367500000X
Certified Registered Nurse Anesthetist
133854
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
29781
TN
Other
Enumeration date
10/05/2020
Last updated
07/09/2021
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