Provider Demographics
NPI:1750538526
Name:BLAKELY, PAUL ELLIET (LVN)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ELLIET
Last Name:BLAKELY
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-4144
Mailing Address - Country:US
Mailing Address - Phone:661-326-2000
Mailing Address - Fax:
Practice Address - Street 1:1830 FLOWER ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4144
Practice Address - Country:US
Practice Address - Phone:661-326-5435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN168899164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse