Individual
BRIAN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3304 E I 80 SERVICE RD, CHEYENNE, WY 82009-8781
(307) 829-7355
Mailing address
2560 BUSINESS PKWY STE A, MINDEN, NV 89423-8961
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/09/2025
Last updated
01/09/2025
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