Provider Demographics
NPI:1780269134
Name:BLACKMON, VERONICA ERICKA (PN)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:ERICKA
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:PN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 WADSWORTH BYPASS
Mailing Address - Street 2:STE. 100
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003
Mailing Address - Country:US
Mailing Address - Phone:303-935-7004
Mailing Address - Fax:
Practice Address - Street 1:6303 WADSWORTH BYPASS
Practice Address - Street 2:STE. 100
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003
Practice Address - Country:US
Practice Address - Phone:303-935-7004
Practice Address - Fax:303-935-3035
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0336307164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse