Individual
MR. CHARLES BARTLETT BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
208 N 36TH ST, NIXA, MO 65714-7560
(417) 343-4202
(417) 869-1521
Mailing address
208 N 36TH ST, NIXA, MO 65714-7560
(417) 343-4202
(417) 869-1521
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
088073
MO
Other
Enumeration date
07/27/2006
Last updated
07/08/2007
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