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1154844504
BLAKE VICENT IRELAND
NORTHFIELD, VT
NPI
1154844504
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2017-07-18
Last Update Date
2017-07-18
Business Address
Mr. BLAKE VICENT IRELAND
158 HARMON DR
NORTHFIELD, VT 05663-1000
Phone number: 203-565-1815
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Mailing Address
Mr. BLAKE VICENT IRELAND
93 DIXIE AVE
WATERBURY, CT 06706-1604
Phone number: 203-757-0636
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