Most Relevant Information
Provider Data
| NPI Number: | 1003451097 |
| Provider Name: | JESSE LAGERBLADE |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | LN93551 |
Most Important Dates
| Enumeration Date: | 11/13/2019 |
| Last Updated: | 11/13/2019 |
Provider Practice Location
20 SCHOOL ST
LYNN
MA
019022952
Practice Location Phone/Fax
| Phone: | 7817152390 |
| Fax: | 7817152423 |
Provider Mailing Location
20 SCHOOL ST
LYNN
MA
019022952
Provider Mailing Phone/Fax
| Phone: | 7817152390 |
| Fax: | 7817152423 |