Provider Demographics
NPI:1598299307
Name:BLAKE, KELSEY ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ELIZABETH
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 1:116 CROCKER LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3114
Mailing Address - Country:US
Mailing Address - Phone:541-556-2154
Mailing Address - Fax:
Practice Address - Street 1:116 CROCKER LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3114
Practice Address - Country:US
Practice Address - Phone:541-556-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula