Healthcare Provider Details

I. General information

NPI: 1285031344
Provider Name (Legal Business Name): PAIGE BLACKWOOD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 HIGHWAY 31 SOUTH
DECATUR AL
35603
US

IV. Provider business mailing address

1316 SOMERVILLE RD SE SUITE 1
DECATUR AL
35601-4305
US

V. Phone/Fax

Practice location:
  • Phone: 256-260-7361
  • Fax: 256-341-0747
Mailing address:
  • Phone: 256-260-7361
  • Fax: 256-341-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1-141808
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: