Provider Demographics
NPI:1124217427
Name:BLACKMON, RHONDA MARCALE (LPN)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:MARCALE
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:LPN
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 280461
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29228-0461
Mailing Address - Country:US
Mailing Address - Phone:803-665-7560
Mailing Address - Fax:
Practice Address - Street 1:141 VILLAS CT APT A
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-1386
Practice Address - Country:US
Practice Address - Phone:803-665-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP27456164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse