Most Relevant Information
Provider Data
| NPI Number: | 1003203803 |
| Provider Name: | REGINA BLAKE |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | PN 092709 |
Most Important Dates
| Enumeration Date: | 04/20/2015 |
| Last Updated: | 04/20/2015 |
Provider Practice Location
7757 AUBURN RD
CONCORD TWP
OH
440779609
Practice Location Phone/Fax
| Phone: | 4403502547 |
| Fax: |
Provider Mailing Location
7757 AUBURN RD
CONCORD TWP
OH
440779609
Provider Mailing Phone/Fax
| Phone: | 4403502547 |
| Fax: |