Individual
MATTHEW LEE BLADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4646 W PIONEER RD, DULUTH, MN 55803-9347
(218) 256-0238
Mailing address
4646 W PIONEER RD, DULUTH, MN 55803-9347
(218) 256-0238
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
062108-1
MN
372500000X
Chore Provider
—
—
376J00000X
Homemaker
062108-1
MN
Other
Enumeration date
03/16/2010
Last updated
03/16/2010
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