Blake, Leila Icillda

Blake, Leila Icillda is an individual health care provider with primary practice located at 121 15 194 Street Springfield Gardens, Queens NY 11413. She recently has only one registered license in Nursing Service Providers / Licensed Practical Nurse, which is considered as her primary health care specialty. Blake, Leila Icillda can be contacted via phone (718) 949-3421.

Contact Information

Primary practice address
121 15 194 Street Springfield Gardens Queens NY 11413
Phone: (718) 949-3421
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Practical Nurse 164W00000X 1651541 New York

Profile Details

NPI number 1033252218
LBN Legal business name Blake, Leila Icillda
Credentials Licensed Practical Nurse (LPN)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 15th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033252218 NPPES
New York MEDICAID 02570390

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