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General NPI Number Information
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NPI Number | 1881471407
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Entity Type | Individual
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Provider Name | TONIA ANNETTE BLACKWELL LPN
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Gender | Female
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 520 THURGOOD MARSHALL HWY
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City | KINGSTREE
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State | SC
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Zip | 29556-4108
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Country | US
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Telephone | 843-355-6012
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Fax |
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Provider Business Mailing Address
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Address Line | 405 S FIRE STATION RD
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City | JOHNSONVILLE
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State | SC
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Zip | 29555-5230
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Country | US
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Telephone | 843-992-9144
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Fax |
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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 | 364SC1501X
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Taxonomy Name | Community Health/Public Health Clinical Nurse Specialist
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License Number | 43924
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License Number State | SC
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