Individual
DANIELLE RENAE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 S WACKER DR FL 31, CHICAGO, IL 60606-5877
(866) 849-0692
Mailing address
5020 N ILLINOIS ST, FAIRVIEW HEIGHTS, IL 62208-3411
(618) 222-8900
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2020019717
MO
363LF0000X
Family Nurse Practitioner
Primary
209021461
IL
363LF0000X
Family Nurse Practitioner
A179227
IA
363LF0000X
Family Nurse Practitioner
NPPA075406
PA
Other
Enumeration date
07/07/2020
Last updated
04/15/2026
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