Provider Demographics
NPI:1376875005
Name:BLAKE, YVONNE VALARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:VALARIE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E 93RD ST
Mailing Address - Street 2:APT #3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-2226
Mailing Address - Country:US
Mailing Address - Phone:718-778-4678
Mailing Address - Fax:
Practice Address - Street 1:218 SMITH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6437
Practice Address - Country:US
Practice Address - Phone:718-693-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223554-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse