MEDICARE: KARENE ORTENSA BLAKE 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	163WC1500X	Community Health Registered Nurse	572305	NY

General Provider Information

NPI Number	:	1356800601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARENE ORTENSA BLAKE RN

Provider Business Mailing Address
First Line	:	1584 KENNETH AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-1659
Country	:	US
Telephone Number	:	646-478-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1584 KENNETH AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-1659
Country	:	US
Telephone Number	:	646-478-6900
Fax Number	:

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

Provider Enumeration Date	:	03/17/2019
Last Update Date	:	03/17/2019

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