MEDICARE: BLAKE ULVELING RN

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
1	163WC0200X	Critical Care Medicine Registered Nurse	802247	CA

General Provider Information

NPI Number	:	1336071190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE ULVELING RN

Provider Business Mailing Address
First Line	:	2505 ACTON ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2111
Country	:	US
Telephone Number	:	510-387-2842
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 ACTON ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2111
Country	:	US
Telephone Number	:	510-387-2842
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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