Most Relevant Information
Provider Data
| NPI Number: | 1003488610 |
| Provider Name: | CRISTAL BLACKBURN |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/13/2021 |
| Last Updated: | 07/13/2021 |
Provider Practice Location
139 PARK AVE
ELKINS
WV
262415255
Practice Location Phone/Fax
| Phone: | 3047047175 |
| Fax: |
Provider Mailing Location
139 PARK AVE
ELKINS
WV
262415255
Provider Mailing Phone/Fax
| Phone: | 3047047175 |
| Fax: |