Doctor Name: | ANNE B BLAKE |
NPI Number: | 1225089857 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 1450 |
Business Practice Address: | 710 Dewitt Dr Lugoff, SC - 290789069 |
Business Phone Number: | 8034387566 |
Business Fax Number: | 8034384371 |
Mailing Address: | Po Box 1259, CAMDEN |
State: | SC |
Postal Code: | 290211259 |
Phone Number: | 8037138350 |
Fax Number: | 8037138433 |
NPI Enumeration Date: | 05/16/2006 |
NPI Last Update Date: | 02/24/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1450 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |