Healthcare Provider Details

I. General information

NPI: 1215878178
Provider Name (Legal Business Name): BLAKE POU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 TRENT DR
DURHAM NC
27710-3038
US

IV. Provider business mailing address

1968 BIG FALLS DR
WENDELL NC
27591-6877
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-4248
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number324088
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: