Individual
VICKY MAE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
116 CHASE ROAD, ATHOL, MA 01331
(978) 249-4794
Mailing address
116 CHASE ROAD, ATHOL, MA 01331
(978) 249-4794
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN59554
MA
Other
Enumeration date
12/06/2012
Last updated
12/06/2012
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