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General NPI Number Information
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NPI Number | 1053264689
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Entity Type | Individual
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Provider Name | OLIVIA BLAKE
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Gender | Female
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 2121 I ST NW
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City | WASHINGTON
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State | DC
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Zip | 20052-0086
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Country | US
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Telephone | 202-994-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 TOWN SIDE DR
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City | APEX
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State | NC
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Zip | 27502-6803
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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