Individual
DR. MARISSA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-6000
Mailing address
128 BASSETT RD, NORTH HAVEN, CT 06473-1903
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
9811
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/30/2021
Last updated
02/27/2022
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