Individual
MANDY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
129 WOODSON ST, SALISBURY, NC 28144-3255
(704) 636-5576
(704) 216-2011
Mailing address
129 WOODSON ST, SALISBURY, NC 28144-3255
(704) 636-5576
(704) 216-2011
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5006329
NC
363LP0200X
Pediatric Nurse Practitioner
Primary
5006329
NC
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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