Individual
DANIELLE REBECCA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1055 BOWLES AVE STE 200, FENTON, MO 63026-2308
(636) 496-3900
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2013025839
MO
363L00000X
Nurse Practitioner
Primary
2018011508
MO
Other
Enumeration date
11/06/2018
Last updated
12/18/2024
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