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General NPI Number Information
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NPI Number | 1568530590
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Entity Type | Individual
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Provider Name | KARLA R BLACKWOOD APRN
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 535 FORTUNE DR STE 100
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City | PAPILLION
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State | NE
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Zip | 68046-3429
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Country | US
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Telephone | 402-933-2222
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Fax | 402-505-3886
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Provider Business Mailing Address
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Address Line | 535 FORTUNE DR STE 100
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City | PAPILLION
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State | NE
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Zip | 68046-3429
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Country | US
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Telephone | 402-933-2222
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Fax | 402-505-3886
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 110102
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License Number State | NE
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