Healthcare Provider Details

I. General information

NPI: 1508915208
Provider Name (Legal Business Name): EDWARD J BLACHE JR. RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 ATHANIA PKWY
METAIRIE LA
70001-5205
US

IV. Provider business mailing address

307 ATHANIA PKWY
METAIRIE LA
70001-5205
US

V. Phone/Fax

Practice location:
  • Phone: 888-322-6432
  • Fax: 888-329-6432
Mailing address:
  • Phone: 888-322-6432
  • Fax: 888-329-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN057578
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: