MEDICARE: MS. ANGELA L. BLACKMAN C.N.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	CN0000056958	GA

General Provider Information

NPI Number	:	1356643464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA L. BLACKMAN C.N.A.

Provider Business Mailing Address
First Line	:	4653 LEE ROAD 379
Second Line	:
City	:	SALEM
State	:	AL
Zip	:	36874-3607
Country	:	US
Telephone Number	:	334-291-7629
Fax Number	:	334-297-8711

Provider Business Practice Location Address
First Line	:	4653 LEE ROAD 379
Second Line	:
City	:	SALEM
State	:	AL
Zip	:	36874-3607
Country	:	US
Telephone Number	:	334-291-7629
Fax Number	:	334-297-8711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	11/22/2010

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Directions to “ MS. ANGELA L. BLACKMAN C.N.A.” Practice Location

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