Provider Demographics
NPI:1437371077
Name:BLAKE, DAWN M
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:BLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43777-1113
Mailing Address - Country:US
Mailing Address - Phone:740-697-0077
Mailing Address - Fax:
Practice Address - Street 1:100 1/2 OLD RAINER ROAD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43777
Practice Address - Country:US
Practice Address - Phone:740-697-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2609878OtherINDEPENDANT PROVIDER NUMB