Individual
LISA DIANE BLACKETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 552-6713
Mailing address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 552-0222
(361) 552-0220
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209010216
IL
Other
Enumeration date
02/07/2013
Last updated
07/06/2026
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