| NPI | 1063828671 |
|---|---|
| Former Name | TRACIE BLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 16862) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 613828) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2016-01-19 |