Individual
MRS. HALEY ELISE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1836 W GEORGIA RD, SIMPSONVILLE, SC 29680-7212
(864) 675-1700
(864) 675-1705
Mailing address
1836 W GEORGIA RD, SIMPSONVILLE, SC 29680-7212
(864) 675-1700
(864) 675-1705
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
18023
SC
Other
Enumeration date
10/31/2012
Last updated
10/31/2012
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