Individual
MR. CHARLES EDWARD BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
17215 N 72ND DR BLDG D, GLENDALE, AZ 85308-8558
(480) 214-9000
(480) 214-9999
Mailing address
2051 W CHANDLER BLVD STE 5, CHANDLER, AZ 85224-6239
(480) 214-9000
(480) 214-9999
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP2395
AZ
Other
Enumeration date
12/18/2006
Last updated
05/09/2024
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