Provider Demographics
NPI:1265656987
Name:BLACKMAN, KATRIENA LASHAUN (LVN)
Entity Type:Individual
Prefix:MS
First Name:KATRIENA
Middle Name:LASHAUN
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 EAGLE RIVER TRL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-4922
Mailing Address - Country:US
Mailing Address - Phone:214-371-6639
Mailing Address - Fax:
Practice Address - Street 1:3330 LANCASTER ROAD
Practice Address - Street 2:DALLAS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4545
Practice Address - Country:US
Practice Address - Phone:214-371-6639
Practice Address - Fax:214-372-6199
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196120164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse