| NPI | 1093354458 |
|---|---|
| Former Name | AMBER LANAE BLACKWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-129220) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-129220) |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2021-02-12 |