Healthcare Provider Details

I. General information

NPI: 1588476592
Provider Name (Legal Business Name): LAURA BLACKSTONE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N BRAGG AVE
LOOKOUT MOUNTAIN TN
37350-1205
US

IV. Provider business mailing address

70 BRUMBY RD
FLINTSTONE GA
30725-2441
US

V. Phone/Fax

Practice location:
  • Phone: 423-821-6116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN260363
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN260363
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: