Provider Demographics
NPI:1750057709
Name:BLACKWOOD-PALMER, ANN-MARIE JENICE
Entity Type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:JENICE
Last Name:BLACKWOOD-PALMER
Suffix:
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 1:56 N RUBY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-2640
Mailing Address - Country:US
Mailing Address - Phone:267-951-4368
Mailing Address - Fax:
Practice Address - Street 1:56 N RUBY ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-2640
Practice Address - Country:US
Practice Address - Phone:267-951-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion