| NPI | 1801833892 |
|---|---|
| Former Name | CARENA M. BLACKETER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 336.086682) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 3676) |
| 207Q00000X Family Medicine (Licence: IL 036123865) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2011-11-22 |