Individual
SHAWN C BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
235 8TH AVE W, CRESCO, IA 52136-1062
(563) 547-2101
(563) 547-3448
Mailing address
235 8TH AVE W, CRESCO, IA 52136-1062
(563) 547-2101
(563) 547-3448
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
D116603
IA
367500000X
Certified Registered Nurse Anesthetist
Primary
D116603
IA
Other
Enumeration date
04/28/2015
Last updated
11/09/2023
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