Individual
JENNIFER LEE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4188
(860) 646-1222
Mailing address
159 ANNA FARM RD E, NORTH STONINGTON, CT 06359-1035
(401) 741-9862
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
12319
CT
Other
Enumeration date
09/12/2023
Last updated
09/15/2023
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