Provider Demographics
NPI:1376188334
Name:BLACKWELL, EMILY PRICE (LPN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:PRICE
Last Name:BLACKWELL
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 1:420 HIGH POINT CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728-6458
Mailing Address - Country:US
Mailing Address - Phone:843-925-2832
Mailing Address - Fax:
Practice Address - Street 1:420 HIGH POINT CHURCH RD
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728-6458
Practice Address - Country:US
Practice Address - Phone:843-925-2832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP32134164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse