Provider Demographics
NPI:1073781993
Name:BLACKSTON, CECELIA IRENE (MBA)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:IRENE
Last Name:BLACKSTON
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1401
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5401
Mailing Address - Country:US
Mailing Address - Phone:610-879-6423
Mailing Address - Fax:267-988-8981
Practice Address - Street 1:67 BUCK RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1535
Practice Address - Country:US
Practice Address - Phone:610-879-6423
Practice Address - Fax:267-988-8981
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider