Individual
JANE R BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7 COMMUNITY DR, BUFFALO, NY 14225-2523
(716) 505-5630
(716) 892-1936
Mailing address
2356 N FOREST RD, GETZVILLE, NY 14068-1224
(716) 505-5630
(716) 892-1936
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F300173
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000560368001
UNIVERA
NY
01
—
500006815
MEDICARE RAILROAD
NY
Enumeration date
07/12/2006
Last updated
07/08/2007
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