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Individual

ANGELA MARIE BLAKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
500 W SILVER SPRING DR STE 200, GLENDALE, WI 53217-5051
(414) 510-9212
Mailing address
6535 N ATWAHL DR, GLENDALE, WI 53209-3403

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
147913
WI

Other

Enumeration date
05/20/2018
Last updated
05/20/2018
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