Individual
JESSICA ANNE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-NP, FNP-C
Contact information
Practice address
11949 Q ST, OMAHA, NE 68137-3503
(402) 595-1326
Mailing address
11949 Q ST, OMAHA, NE 68137-3503
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
112873
NE
Other
Enumeration date
01/21/2020
Last updated
01/21/2020
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