Individual
DONNA MARIE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1635 CENTRAL AVE, BRIDGEPORT, CT 06610-2717
(203) 551-7091
Mailing address
1635 CENTRAL AVE, BRIDGEPORT, CT 06610-2717
(203) 551-7091
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
68942
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68942
DPH
CT
Enumeration date
06/28/2021
Last updated
06/28/2021
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