| NPI | 1952739864 |
|---|---|
| Former Name | TERESA BLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60758211) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95000075) |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2022-04-12 |