Provider Demographics
NPI:1255095519
Name:BLACKSTOCK, DARCI (RN)
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:
Last Name:BLACKSTOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DARCI
Other - Middle Name:
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1298 MAIN ST # A4162
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-7904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1298 MAIN ST # A4162
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-7904
Practice Address - Country:US
Practice Address - Phone:970-691-8498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0170661163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse