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NPI Code Detail

MEDICARE: BLAKE QUALLS

MEDICARE: BLAKE QUALLS
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
1163W00000XRegistered NurseRN.1678975CO

General Provider Information

NPI Number : 1336085133
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE QUALLS
Provider Business Mailing Address
First Line : 1100 NORTH AVE
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-3122
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1100 NORTH AVE
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-3122
Country : US
Telephone Number : 970-298-2565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2026
Last Update Date : 04/25/2026

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Directions to “ BLAKE QUALLS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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