Basic Information
| Provider Information | |||||||||
| NPI: | 1265656987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACKMAN | ||||||||
| FirstName: | KATRIENA | ||||||||
| MiddleName: | LASHAUN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.V.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1743 EAGLE RIVER TRL | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751464922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143716639 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3330 LANCASTER ROAD | ||||||||
| Address2: | DALLAS | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752164545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143716639 | ||||||||
| FaxNumber: | 2143726199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 196120 | TX | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.