Provider Demographics
NPI:1487229415
Name:BLAKE, ANDREA S (BLOODBORNE PATHOLOGI)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:S
Last Name:BLAKE
Suffix:
Gender:F
Credentials:BLOODBORNE PATHOLOGI
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:S
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANDREA S BLAKE CNASM
Mailing Address - Street 1:6054 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6210
Mailing Address - Country:US
Mailing Address - Phone:609-761-8762
Mailing Address - Fax:
Practice Address - Street 1:6054 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-6210
Practice Address - Country:US
Practice Address - Phone:609-761-8762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ.171400000X
NJ171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach