Provider Demographics
NPI:1649214339
Name:BLAKE, CHERYL YVETTE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:YVETTE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8744 GOLDFIELDS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-2660
Mailing Address - Country:US
Mailing Address - Phone:215-681-8661
Mailing Address - Fax:
Practice Address - Street 1:65 JIMMIE LEES RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240
Practice Address - Country:US
Practice Address - Phone:609-652-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR09256900367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered