Provider Demographics
NPI:1225846918
Name:BLAYLOCK, NICOLE BELIT
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BELIT
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:BELIT
Other - Last Name:LYDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DOULA
Mailing Address - Street 1:3700 LYON RD APT 50
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7979
Mailing Address - Country:US
Mailing Address - Phone:602-466-0615
Mailing Address - Fax:
Practice Address - Street 1:3700 LYON RD APT 50
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7979
Practice Address - Country:US
Practice Address - Phone:602-466-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula