| NPI | 1669813432 |
|---|---|
| Former Name | KELLEY BLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH COA.15794-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.372426-) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2014-04-16 |