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Individual
BLAKE DALFERES
Active
Individual
BLAKE DALFERES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
217193
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217193
LICENSE
LA
Enumeration date
06/28/2025
Last updated
05/29/2026
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