Provider Demographics
NPI:1063764603
Name:BLACKWELDER TAYLOR, LINDSEY (BSN)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:BLACKWELDER TAYLOR
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:JEAN
Other - Last Name:BLACKWELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:LIMON
Mailing Address - State:CO
Mailing Address - Zip Code:80828-0574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:252 S 14TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-2321
Practice Address - Country:US
Practice Address - Phone:719-346-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0196656163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse