Individual
ERICA N BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
332 6TH AVE, SOUTH CHARLESTON, WV 25303-1269
(304) 757-9333
Mailing address
158 HIGHLAWN AVE, MILTON, WV 25541-8553
(304) 305-0875
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
32220
WV
Other
Enumeration date
06/26/2022
Last updated
06/26/2022
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