| NPI | 1730290990 |
|---|---|
| Former Name | NICOLE LEA BLACKWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04862) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA04862) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-05-18 |