Individual
BLAKE KATHLEEN GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
2525 CHICAGO AVE, MINNEAPOLIS, MN 55404-4518
(612) 813-7888
(612) 813-6361
Mailing address
10860 KINGSBOROUGH TRL, COTTAGE GROVE, MN 55016-4660
(651) 769-5002
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
8198
MN
363LP0222X
Critical Care Pediatric Nurse Practitioner
209018598
IL
Other
Enumeration date
01/09/2019
Last updated
05/26/2021
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