Individual
VICTORIA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
395 LIBERTY ST, SPRINGFIELD, MA 01104-3779
(413) 272-1333
Mailing address
395 LIBERTY ST, SPRINGFIELD, MA 01104-3779
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN96722
MA
Other
Enumeration date
03/12/2020
Last updated
03/12/2020
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