Provider Demographics
NPI:1215221544
Name:BLAKE, LYNNETTE R (ND)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:R
Last Name:BLAKE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NW FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-600-5815
Mailing Address - Fax:772-600-8012
Practice Address - Street 1:701 NW FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-600-5815
Practice Address - Fax:772-600-8012
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No175L00000XOther Service ProvidersHomeopath