Individual
PENJIT BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4412 73RD PL, URBANDALE, IA 50322-1122
(515) 252-8689
(515) 276-3663
Mailing address
4412 73RD PL, URBANDALE, IA 50322-1122
(515) 252-8689
(515) 276-3663
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
108568
IA
Other
Enumeration date
01/24/2008
Last updated
01/24/2008
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