| NPI | 1083045074 |
|---|---|
| Former Name | OCTAVIA LYNNE BLACKWELDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: NY 421379) |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2020-11-24 |