| NPI | 1942613856 |
|---|---|
| Other Name | REINA LUCILLE BLACKWOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101268005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP03185) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2023-01-05 |