Provider Demographics
NPI:1629390828
Name:BLACKFORD, TONETTE YVONNE (LPN)
Entity type:Individual
Prefix:MS
First Name:TONETTE
Middle Name:YVONNE
Last Name:BLACKFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6528
Mailing Address - Country:US
Mailing Address - Phone:740-389-5217
Mailing Address - Fax:
Practice Address - Street 1:1497 BETHLEHEM RD E
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-9111
Practice Address - Country:US
Practice Address - Phone:740-726-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.046979164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse