Provider Demographics
NPI:1528833555
Name:BLACKWELDER, SARAH FRANCES (LPN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:FRANCES
Last Name:BLACKWELDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MALDEN RD
Mailing Address - Street 2:
Mailing Address - City:MATTYDALE
Mailing Address - State:NY
Mailing Address - Zip Code:13211-1251
Mailing Address - Country:US
Mailing Address - Phone:315-217-1107
Mailing Address - Fax:
Practice Address - Street 1:135 MALDEN RD
Practice Address - Street 2:
Practice Address - City:MATTYDALE
Practice Address - State:NY
Practice Address - Zip Code:13211-1251
Practice Address - Country:US
Practice Address - Phone:315-217-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288194164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse