Marvalene Amanda Blades, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

132322 Issued in CA

Practice address

1427 W Jefferson Blvd
Los Angeles, CA 90007-3419

Phone

(323) 730-8063

Fax

(323) 730-8063

NPI assigned

Sep 1, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188604800000",
    "number": "1457545444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1427 W JEFFERSON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900073419",
            "telephone_number": "323-730-8063",
            "fax_number": "323-730-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1427 W JEFFERSON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900073419",
            "telephone_number": "323-730-8063",
            "fax_number": "323-730-8063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLADES",
        "first_name": "MARVALENE",
        "middle_name": "AMANDA",
        "name_prefix": "Ms.",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-01",
        "last_updated": "2007-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "132322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EPSO014480",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RVN002830",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keith Edward Blackwell, MD
• Keiyana Janae Blackwell, LVN
• Mya Blackwell
• Pamela S Blackwell
• Shawnakay Natalee Blackwood
• Barrisford Buchanan Bladon
• Troy Blain
• Regina Roschele Blaine
• Robyn Day Blaine
• Blair Bishop, Licensed Marriage & Family Therapist

• Licensed Vocational Nurse in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.