Provider Demographics
NPI:1134463268
Name:BLACKWOOD, ALISA (CD(DONA))
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1261
Mailing Address - Country:US
Mailing Address - Phone:612-618-8689
Mailing Address - Fax:
Practice Address - Street 1:941 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1261
Practice Address - Country:US
Practice Address - Phone:612-618-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula