Healthcare Provider Details

I. General information

NPI: 1518300805
Provider Name (Legal Business Name): CHEMWAPUWA BLACKMAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 GENERALLE DEGAULLE DR. 4070
NEW ORLEANS LA
70114
US

IV. Provider business mailing address

1712 ORETHA CASTLE HALEY BLVD APT 204
NEW ORLEANS LA
70113-1372
US

V. Phone/Fax

Practice location:
  • Phone: 504-363-7449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: