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General NPI Number Information
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NPI Number | 1942912076
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Entity Type | Individual
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Provider Name | BLAKE KREK APRN
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Gender | Male
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 975 KIRMAN AVE
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City | RENO
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State | NV
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Zip | 89502-0993
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Country | US
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Telephone | 775-829-5685
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Fax |
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Provider Business Mailing Address
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Address Line | 1073 DORTMUNDER DR
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City | SPARKS
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State | NV
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Zip | 89441-5848
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Country | US
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Telephone | 775-303-2377
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 860037
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License Number State | NV
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