Individual
EBONEE MONIQUE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, CRNA
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1379
(630) 933-6675
(630) 933-2614
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1379
(630) 933-6675
(630) 933-2614
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041422578
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209025731
IL
Other
Enumeration date
04/12/2022
Last updated
07/16/2024
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