Individual
SHAWNA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3929 BETHEL RD, POINT PLEASANT, WV 25550-9594
(304) 675-7400
Mailing address
3929 BETHEL RD, POINT PLEASANT, WV 25550-9594
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
34606
WV
Other
Enumeration date
09/20/2022
Last updated
09/20/2022
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