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NPI Code Detail

MEDICARE: MELINDA K BLAKE NP

MEDICARE: MELINDA K BLAKE NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner28194809AIN
2363LF0000XFamily Nurse Practitioner71006530AIN

General Provider Information

NPI Number : 1780138149
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA K BLAKE NP
Provider Business Mailing Address
First Line : 6330 DIGITAL WAY
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-1667
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6330 DIGITAL WAY
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-1667
Country : US
Telephone Number : 317-473-6688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2016
Last Update Date : 12/09/2023

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