Provider Demographics
NPI:1457547085
Name:BLACKWELL, TRENATTY E (LMP)
Entity type:Individual
Prefix:
First Name:TRENATTY
Middle Name:E
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1614
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0110
Mailing Address - Country:US
Mailing Address - Phone:360-301-6435
Mailing Address - Fax:
Practice Address - Street 1:1634 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-8123
Practice Address - Country:US
Practice Address - Phone:360-301-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA000015607247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other