Individual
DIERA BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
377 CRYSTAL LN, WALTERBORO, SC 29488-8972
(843) 599-3737
Mailing address
377 CRYSTAL LN, WALTERBORO, SC 29488-8972
(843) 599-3737
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
51686
SC
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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