Provider Demographics
NPI:1225371776
Name:SOLOMON, BLAKE LAWRENCE (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:LAWRENCE
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15066 W POST DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-1429
Mailing Address - Country:US
Mailing Address - Phone:602-614-2135
Mailing Address - Fax:
Practice Address - Street 1:3227 E BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2700
Practice Address - Country:US
Practice Address - Phone:602-374-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4830363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health