Individual
TARA NICOLE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3633 SENECA TRL S, PETERSTOWN, WV 24963-5063
(304) 994-1490
Mailing address
3633 SENECA TRL S, PETERSTOWN, WV 24963-5063
(304) 994-1490
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
37492
WV
Other
Enumeration date
12/17/2025
Last updated
12/17/2025
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