TRACI LEIGH BLAKE

ROCKFORD, IL
NPI1649543042
Former NameTRACI L GOODELL
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy163WR0006X Registered Nurse, Registered Nurse First Assistant
(Licence: IL  041336983)
Enumeration Date2012-02-15
Last Update Date2021-06-29
Business Address
TRACI LEIGH BLAKE BSN, RN, CNOR, RNFA
1401 E STATE ST
ROCKFORD, IL 61104-2315
Phone number: 779-696-7150
Mailing Address
TRACI LEIGH BLAKE BSN, RN, CNOR, RNFA
PO BOX 78866
MILWAUKEE, WI 53278-8866
Phone number: 779-696-4400