Healthcare Provider Details

I. General information

NPI: 1124400577
Provider Name (Legal Business Name): SIARA LEONE BLACKWOOD RDMS, RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SIARA LEONE COWAN

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WASHINGTON RD
ASHEVILLE NC
28801-1941
US

IV. Provider business mailing address

77 WASHINGTON RD
ASHEVILLE NC
28801-1941
US

V. Phone/Fax

Practice location:
  • Phone: 828-772-8869
  • Fax:
Mailing address:
  • Phone: 828-772-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number183871
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: