Individual
TRACEY BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
1120 N MARR RD, COLUMBUS, IN 47201-5505
(812) 376-9219
Mailing address
1120 N MARR RD, COLUMBUS, IN 47201-5505
(812) 376-9219
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
11136128
IN
Other
Enumeration date
04/02/2014
Last updated
04/02/2014
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