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Individual

CHRISTINA L BLAKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
106 W GEORGIA RD, SIMPSONVILLE, SC 29681-2302
(864) 662-6840
(864) 448-1720
Mailing address
106 W GEORGIA RD, SIMPSONVILLE, SC 29681-2302
(864) 662-6840
(864) 448-1720

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
225614
SC
363L00000X
Nurse Practitioner
211071
SC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
21071
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
NP4579
SC
01
SCA8307652
MEDICARE PIN
Enumeration date
04/21/2017
Last updated
03/19/2024
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