Individual
JODI BLADES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
1904 RICHLAND AVE, CERES, CA 95307-4562
(209) 300-8800
Mailing address
1733 DALIA LN, MANTECA, CA 95337-8785
(209) 640-3562
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
285373
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164X00000X
—
CA
Enumeration date
06/16/2016
Last updated
06/16/2016
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