Provider Demographics
NPI:1134469059
Name:BLACKSHEAR, CARMEN L (HOME HEALTH AID)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:L
Last Name:BLACKSHEAR
Suffix:
Gender:F
Credentials:HOME HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 N ARROWHEAD DRIVE APT 1
Mailing Address - Street 2:FMI SERVICES LLC
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3590
Mailing Address - Country:US
Mailing Address - Phone:480-786-4986
Mailing Address - Fax:480-786-4986
Practice Address - Street 1:2024 S ROWEN
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6209
Practice Address - Country:US
Practice Address - Phone:480-786-4986
Practice Address - Fax:480-786-4986
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide