Provider Demographics
NPI:1336627934
Name:BLACKBURN, STEVEN JOSEPH (LVN)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSEPH
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2942 BURNT OAK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1804
Mailing Address - Country:US
Mailing Address - Phone:210-771-6453
Mailing Address - Fax:
Practice Address - Street 1:7710 W INTERSTATE 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4711
Practice Address - Country:US
Practice Address - Phone:210-377-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313528164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse