Individual
VICTORIA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 CONGRESS ST, PORTLAND, ME 04102-1908
(207) 221-2292
Mailing address
62 WAINWRIGHT CIR W, SOUTH PORTLAND, ME 04106-2522
(850) 529-6764
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5238837
FL
Other
Enumeration date
07/13/2021
Last updated
07/13/2021
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