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Individual
MRS. BLAKE RAINIE SLACK
Active
Individual
MRS. BLAKE RAINIE SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM, WHNP
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
283129
MA
176B00000X
Midwife
AC000650
MD
363LW0102X
Women's Health Nurse Practitioner
RN283129
MA
367A00000X
Advanced Practice Midwife
Primary
RN283129
MA
Other
Enumeration date
02/07/2009
Last updated
04/28/2016
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