Provider Demographics
NPI:1841726205
Name:BLACKSON, MARTIKA DENISE
Entity type:Individual
Prefix:MISS
First Name:MARTIKA
Middle Name:DENISE
Last Name:BLACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4927 G ST SE
Mailing Address - Street 2:APT. 301
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5954
Mailing Address - Country:US
Mailing Address - Phone:202-489-9926
Mailing Address - Fax:
Practice Address - Street 1:4927 G ST SE
Practice Address - Street 2:APT 301
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5954
Practice Address - Country:US
Practice Address - Phone:202-489-9926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant