Provider Demographics
NPI:1265453161
Name:BLAKE, RACHEL A (MD)
Entity Type:Individual
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First Name:RACHEL
Middle Name:A
Last Name:BLAKE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3201 PIONEERS BLVD
Mailing Address - Street 2:STE 304
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5963
Mailing Address - Country:US
Mailing Address - Phone:402-434-5235
Mailing Address - Fax:402-484-8891
Practice Address - Street 1:2900 S 70TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3688
Practice Address - Country:US
Practice Address - Phone:402-434-5235
Practice Address - Fax:402-484-8891
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2019-01-17
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Provider Licenses
StateLicense IDTaxonomies
NE22566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH92792Medicare UPIN