Provider Demographics
NPI:1275742702
Name:BLEA, EVELYN MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:MARIE
Last Name:BLEA
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:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:PERALTA
Mailing Address - State:NM
Mailing Address - Zip Code:87042-0061
Mailing Address - Country:US
Mailing Address - Phone:505-710-7848
Mailing Address - Fax:
Practice Address - Street 1:5901 ZUNI RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3073
Practice Address - Country:US
Practice Address - Phone:505-841-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NML18582164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse