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General NPI Number Information
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NPI Number | 1225371776
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Entity Type | Individual
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Provider Name | BLAKE LAWRENCE SOLOMON PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 3227 E BELL RD
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City | PHOENIX
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State | AZ
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Zip | 85032-2700
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Country | US
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Telephone | 602-374-7439
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Fax |
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Provider Business Mailing Address
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Address Line | 15066 W POST DR
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City | SURPRISE
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State | AZ
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Zip | 85374-1429
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Country | US
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Telephone | 602-614-2135
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP4830
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License Number State | AZ
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