Provider Demographics
NPI:1790223808
Name:BLAKELEY, ASHLEY BLAKE (RN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BLAKE
Last Name:BLAKELEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3320
Mailing Address - Country:US
Mailing Address - Phone:213-284-3200
Mailing Address - Fax:213-284-3353
Practice Address - Street 1:400 W 30TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3320
Practice Address - Country:US
Practice Address - Phone:213-284-3200
Practice Address - Fax:213-284-3353
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584577163W00000X
MA250631163W00000X
CT72515163W00000X
SC90539163W00000X
FLRN9253577163W00000X
RIRN38532163W00000X
NVRN68057163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse