Provider Demographics
NPI:1710501804
Name:BLACKWOOD, MUREEN AVION X
Entity Type:Individual
Prefix:MS
First Name:MUREEN
Middle Name:AVION
Last Name:BLACKWOOD
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6372 HATTER RD APT 3
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-9700
Mailing Address - Country:US
Mailing Address - Phone:716-266-3484
Mailing Address - Fax:
Practice Address - Street 1:6372 HATTER RD APT 3
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-9700
Practice Address - Country:US
Practice Address - Phone:716-266-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338385164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse