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Individual

BLAKE DALFERES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
X

Contact information

Practice address
620 HONORE DR, JEFFERSON, LA 70121-1607
(985) 285-0675
Mailing address
620 HONORE DR, JEFFERSON, LA 70121-1607
(985) 285-0675

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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