Provider Demographics
NPI:1558800110
Name:BLAY, ANITRA
Entity Type:Individual
Prefix:MRS
First Name:ANITRA
Middle Name:
Last Name:BLAY
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:PO BOX 6856
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70009-6856
Mailing Address - Country:US
Mailing Address - Phone:504-915-4928
Mailing Address - Fax:
Practice Address - Street 1:620 MAGNOLIA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BOUTTE
Practice Address - State:LA
Practice Address - Zip Code:70039-3223
Practice Address - Country:US
Practice Address - Phone:504-915-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA120569163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse