Provider Demographics
NPI:1801224993
Name:BLACKWELL, TAMIKA LAJUAN
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:LAJUAN
Last Name:BLACKWELL
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 1:11410 DECEMBER WAY APT 403
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3625
Mailing Address - Country:US
Mailing Address - Phone:202-271-1074
Mailing Address - Fax:
Practice Address - Street 1:11410 DECEMBER WAY APT 403
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3625
Practice Address - Country:US
Practice Address - Phone:202-271-1074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide