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Individual
MS. REBECCA L BLAKE
Active
Individual
MS. REBECCA L BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
015016
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03788887
—
NY
01
—
140326000191
FIDELIS
NY
Enumeration date
10/04/2011
Last updated
07/17/2026
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