Healthcare Provider Details

I. General information

NPI: 1265453161
Provider Name (Legal Business Name): RACHEL A BLAKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 S 70TH ST SUITE 310
LINCOLN NE
68506-3688
US

IV. Provider business mailing address

3201 PIONEERS BLVD STE 304
LINCOLN NE
68502-5963
US

V. Phone/Fax

Practice location:
  • Phone: 402-434-5235
  • Fax: 402-484-8891
Mailing address:
  • Phone: 402-434-5235
  • Fax: 402-484-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22566
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: