Most Relevant Information
Provider Data
| NPI Number: | 1003055591 |
| Provider Name: | BLAKE RAINIE SLACK CNM, WHNP |
| Entity Type: | Individual |
| Taxonomy Code: | 176B00000X |
| Specialty: | Midwife |
| License Number: | AC000650 |
Most Important Dates
| Enumeration Date: | 02/07/2009 |
| Last Updated: | 04/28/2016 |
Provider Practice Location
55 FRUIT ST, FOUNDERS 454
MASSACHUSETTS GENERAL HOSPITAL
BOSTON
MA
021142621
Practice Location Phone/Fax
| Phone: | 6177262033 |
| Fax: |
Provider Mailing Location
55 FRUIT ST, FOUNDERS 454
MASSACHUSETTS GENERAL HOSPITAL
BOSTON
MA
021142621
Provider Mailing Phone/Fax
| Phone: | 6177262033 |
| Fax: |