| NPI | 1952952939 |
|---|---|
| Former Name | MEGAN LEILANI BLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010134A) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 28193277A) |
| Enumeration Date | 2019-09-22 |
| Last Update Date | 2024-03-21 |