Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath |
NPI | 1215221544 |
---|---|
Provider Name | Lynnette R Blake |
First Address | Stuart, FL 34994 |
Second Address | Stuart, FL 34994 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2011 |
Last Update Date | 03/06/2011 |