Individual
BLAKE BURK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4605 E ELWOOD ST STE 500, PHOENIX, AZ 85040-1978
(480) 256-1518
(480) 304-3446
Mailing address
4605 E ELWOOD ST STE 500, PHOENIX, AZ 85040-1978
(480) 256-1518
(480) 304-3446
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9494883
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
301627
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301627
CRNA LICENSE
AZ
01
—
RN9494883
RN LICENSE
FL
Enumeration date
07/12/2023
Last updated
03/19/2024
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