Individual
MS. TAI BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
755 36TH ST SE, GRAND RAPIDS, MI 49548-2319
(616) 897-5900
(616) 897-5954
Mailing address
6070 IN THE PINES DR SE, KENTWOOD, MI 49548-8503
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704255955
MI
Other
Enumeration date
05/05/2009
Last updated
05/05/2009
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