Provider Demographics
NPI:1801582242
Name:BLACKWELL, ELISE N (DOULA)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:N
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3983 MARINA LAKE RD APT 211
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2031
Mailing Address - Country:US
Mailing Address - Phone:619-677-0146
Mailing Address - Fax:
Practice Address - Street 1:3983 MARINA LAKE RD APT 211
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2031
Practice Address - Country:US
Practice Address - Phone:619-677-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula