Individual
BLAKE REDDICK
Active
Individual
BLAKE REDDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R243734
MD
163WG0000X
General Practice Registered Nurse
041446406
IL
163WG0000X
General Practice Registered Nurse
28235378A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
R243734
MD
Other
Enumeration date
09/03/2019
Last updated
07/16/2020
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