Individual
AMANDA SUE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
334 GRANDVIEW RD, MOUNDSVILLE, WV 26041-5108
(681) 667-0397
Mailing address
334 GRANDVIEW RD, MOUNDSVILLE, WV 26041-5108
(681) 667-0397
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125553494
—
WV
05
—
1356607394
—
WV
05
—
1821206228
—
WV
Enumeration date
12/07/2022
Last updated
12/07/2022
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