Individual
SALLY S BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2319 SAINT MATTHEWS RD, ORANGEBURG, SC 29118
(803) 536-1571
(803) 534-3860
Mailing address
2319 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-2042
(803) 536-1571
(803) 534-3860
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
710
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
710
STATE LICENSE #
SC
01
—
F710
PRESCRIPTIVE AUTHORITY
SC
05
—
NP1060
—
SC
Enumeration date
01/15/2007
Last updated
02/11/2019
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