Individual
AVALON BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
46-202 HAIKU RD, KANEOHE, HI 96744-3806
(808) 233-5677
Mailing address
5100 BINGHAM WAY, KAILUA, HI 96734-5098
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
89669
HI
Other
Enumeration date
04/25/2019
Last updated
04/25/2019
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