Provider Demographics
NPI:1588476592
Name:BLACKSTONE, LAURA (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BLACKSTONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BRUMBY RD
Mailing Address - Street 2:
Mailing Address - City:FLINTSTONE
Mailing Address - State:GA
Mailing Address - Zip Code:30725-2441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 N BRAGG AVE
Practice Address - Street 2:
Practice Address - City:LOOKOUT MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37350-1205
Practice Address - Country:US
Practice Address - Phone:423-821-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN260363163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool