Healthcare Provider Details

I. General information

NPI: 1770249476
Provider Name (Legal Business Name): JOYCE LANELL BLADES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5737 YOUREE DR
SHREVEPORT LA
71105-4216
US

IV. Provider business mailing address

5750 JOHNSTON ST STE 502
LAFAYETTE LA
70503-5334
US

V. Phone/Fax

Practice location:
  • Phone: 318-219-4155
  • Fax:
Mailing address:
  • Phone: 337-417-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: