Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 283129 | MA |
N | 176B00000X | Midwife | AC000650 | MD |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN283129 | MA |
NPI | 1003055591 |
---|---|
Provider Name | Mrs. Blake Rainie Slack |
First Address | Boston, MA 02114-2621 |
Second Address | Boston, MA 02114-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2009 |
Last Update Date | 28/04/2016 |