Individual
TRACI A BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
5023 BUSH HILL RD, CANISTEO, NY 14823-9675
(607) 968-4125
Mailing address
5023 BUSH HILL RD, CANISTEO, NY 14823-9675
(607) 968-4125
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
804067-02
NY
Other
Enumeration date
06/25/2021
Last updated
06/25/2021
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