| NPI | 1386810489 |
|---|---|
| Former Name | COLLEEN BLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NE 110878) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NE 110878) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2021-05-20 |