Individual
PAMELA J BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
619 19TH ST S, BIRMINGHAM, AL 35249-1900
(205) 934-6600
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
1054391
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051521386
BLUE CROSS
AL
01
—
051521387
BLUE CROSS
AL
01
—
051521388
BLUE CROSS
AL
01
—
051521389
BLUE CROSS
AL
01
—
051521390
BLUE CROSS
AL
01
—
051521391
BLUE CROSS
AL
01
—
051521392
BLUE CROSS
AL
01
—
051554939
BLUE CROSS
AL
05
—
891007670
—
AL
05
—
891007680
—
AL
05
—
891007690
—
AL
05
—
891007700
—
AL
05
—
891007710
—
AL
05
—
891007720
—
AL
05
—
891007730
—
AL
Enumeration date
05/24/2006
Last updated
07/30/2012
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