Individual
MS. ANDREA M. BLAKELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
1748 BROOKFIELD SQ N, COLUMBUS, OH 43229-3707
(614) 885-6313
Mailing address
1748 BROOKFIELD SQ N, COLUMBUS, OH 43229-3707
(614) 885-6313
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
374367241194
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2061745
—
OH
Enumeration date
03/26/2007
Last updated
07/09/2007
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