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General NPI Number Information
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NPI Number | 1003496829
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Entity Type | Organization
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Legal Business Name | JANICE BLAKE APRN, PLLC
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 181 THOMPSON ST
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City | S GLASTONBURY
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State | CT
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Zip | 06073-2919
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Country | US
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Telephone | 860-266-7826
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Fax |
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Provider Business Mailing Address
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Address Line | 181 THOMPSON ST
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City | S GLASTONBURY
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State | CT
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Zip | 06073-2919
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | JANICE BLAKE
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Credential | PMHNP-BC
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Telephone | 860-266-7826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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