Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN26323 | FL |
NPI | 1104499227 |
---|---|
Provider Name | Rachel Blakeley |
First Address | Fort Lauderdale, FL 33301-3074 |
Second Address | Plantation, FL 33322-5435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2021 |
Last Update Date | 19/07/2021 |