Individual
GENAE BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12716 NE 36TH ST, SPENCER, OK 73084-9167
(405) 769-3301
Mailing address
PO BOX 30589, MIDWEST CITY, OK 73140-3589
(405) 769-3301
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
29398
OK
Other
Enumeration date
06/22/2020
Last updated
06/22/2020
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