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NPI Code Detail

MEDICARE: DANIELLE RENAE BLAKE

MEDICARE: DANIELLE RENAE BLAKE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209021461IL
2363LF0000XFamily Nurse Practitioner2020019717MO
3363LF0000XFamily Nurse PractitionerA179227IA
4363LF0000XFamily Nurse PractitionerNPPA075406PA

General Provider Information

NPI Number : 1295353308
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE RENAE BLAKE
Provider Business Mailing Address
First Line : 5020 N ILLINOIS ST
Second Line :
City : FAIRVIEW HEIGHTS
State : IL
Zip : 62208-3411
Country : US
Telephone Number : 618-222-8900
Fax Number :
Provider Business Practice Location Address
First Line : 200 S WACKER DR FL 31
Second Line :
City : CHICAGO
State : IL
Zip : 60606-5877
Country : US
Telephone Number : 866-849-0692
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2020
Last Update Date : 04/15/2026

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Directions to “ DANIELLE RENAE BLAKE ” Practice Location

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