Individual
MRS. ANGELA LYNN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
16760 N HIGHWAY 41, RATHDRUM, ID 83858-8715
(208) 687-5627
Mailing address
PO BOX 1387, HAYDEN, ID 83835-1387
(208) 415-0299
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
747465
ID
363LF0000X
Family Nurse Practitioner
747465
ID
Other
Enumeration date
08/15/2023
Last updated
12/19/2024
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