Provider Demographics
NPI:1104579952
Name:BLACKWELL, DEBBIE JUNE
Entity type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:JUNE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BAYSIDE AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2354
Mailing Address - Country:US
Mailing Address - Phone:571-575-5565
Mailing Address - Fax:
Practice Address - Street 1:1301 BAYSIDE AVE APT 6
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2354
Practice Address - Country:US
Practice Address - Phone:571-575-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion