Provider Demographics
NPI:1003638511
Name:BLACKWELL, DENISE HOLLY (BACHELOR AS)
Entity type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:HOLLY
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:BACHELOR AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-2016
Mailing Address - Country:US
Mailing Address - Phone:607-427-6978
Mailing Address - Fax:
Practice Address - Street 1:8 STANLEY ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2016
Practice Address - Country:US
Practice Address - Phone:607-427-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630288992347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle