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NPI Code Detail

MEDICARE: AMANDA BLAKE

MEDICARE: AMANDA 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
1231H00000XAudiologist

General Provider Information

NPI Number : 1972944106
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA BLAKE
Provider Business Mailing Address
First Line : 2510 E SUNSET RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3511
Country : US
Telephone Number : 702-798-0113
Fax Number :
Provider Business Practice Location Address
First Line : 3120S RAINBOW BLVD 202
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-6235
Country : US
Telephone Number : 702-527-6058
Fax Number : 702-527-6057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2013
Last Update Date : 10/05/2015

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Directions to “ AMANDA BLAKE ” Practice Location

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