Individual
BLAKE WOLLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7060 WAYSIDE DR, MENTOR, OH 44060-6527
(440) 357-2770
Mailing address
2157 LAKELAND AVE, LAKEWOOD, OH 44107-5715
(740) 457-6815
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.0031396
OH
Other
Enumeration date
08/01/2022
Last updated
08/01/2022
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