Doctor Name: | MRS. KATHLEEN S BLAKE |
NPI Number: | 1588645287 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ANP |
License Number: | 107061 |
Business Practice Address: | 223 Chief Justice Cushing Hwy Ste 301 Cohasset, MA - 020251391 |
Business Phone Number: | 7813836261 |
Business Fax Number: | 7813831084 |
Mailing Address: | 223 Chief Justice Cushing Hwy, Ste 301 COHASSET |
State: | MA |
Postal Code: | 020251391 |
Phone Number: | 7813836261 |
Fax Number: | 7813831084 |
NPI Enumeration Date: | 11/09/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 107061 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |