Provider Demographics
NPI:1871650754
Name:BLACKMAN, GWENDOLYN LEFRAN (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:LEFRAN
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 CATO RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-3626
Mailing Address - Country:US
Mailing Address - Phone:615-473-3895
Mailing Address - Fax:
Practice Address - Street 1:1211 21ST AVENUE SOUTH
Practice Address - Street 2:MEDICAL ARTS BLDG SUITE 607
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-1320
Practice Address - Country:US
Practice Address - Phone:615-936-3952
Practice Address - Fax:615-936-3956
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN1053133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3241298Medicare ID - Type Unspecified