Individual
GAIL ANN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
100 MACK AVE, DETROIT, MI 48201-2416
(313) 494-2729
Mailing address
6115 MAPLE ST, DEARBORN, MI 48126-2278
(313) 584-3286
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703043275
MI
Other
Enumeration date
11/09/2009
Last updated
11/09/2009
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