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Individual
BLAKE KATHLEEN GOMEZ
Active
Individual
BLAKE KATHLEEN GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
8198
MN
363LP0222X
Critical Care Pediatric Nurse Practitioner
209018598
IL
Other
Enumeration date
01/09/2019
Last updated
05/26/2021
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