Individual
MR. BLAKE M WOODS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, APN, AGNP-C
Contact information
Practice address
1203 W 10TH ST, METROPOLIS, IL 62960-2433
(618) 524-3795
Mailing address
503 W 19TH ST, METROPOLIS, IL 62960-1104
(618) 638-0208
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041336078
IL
163W00000X
Registered Nurse
1102339
KY
363LP2300X
Primary Care Nurse Practitioner
Primary
209012171
IL
363LP2300X
Primary Care Nurse Practitioner
3009061
KY
Other
Enumeration date
10/26/2014
Last updated
12/01/2020
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