Provider Demographics
NPI:1750713095
Name:BLACKWOOD, CHERYL ALLYSON (PA-C)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ALLYSON
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ALLYSON
Other - Last Name:HARTSHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4740 PEARL PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3078
Mailing Address - Country:US
Mailing Address - Phone:303-449-2730
Mailing Address - Fax:303-449-5821
Practice Address - Street 1:4740 PEARL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3078
Practice Address - Country:US
Practice Address - Phone:303-449-2730
Practice Address - Fax:303-449-5821
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0003763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant