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Individual
TRACI LEIGH BLAKE
Active
Individual
TRACI LEIGH BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP,ACNPC-AG, CRNFA
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
041336983
IL
363LA2100X
Acute Care Nurse Practitioner
Primary
209032163
IL
Other
Enumeration date
02/15/2012
Last updated
05/01/2025
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