Provider Demographics
NPI:1821429481
Name:BLAKE, DONNA MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8902 N MERIDIAN ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5382
Mailing Address - Country:US
Mailing Address - Phone:317-581-8888
Mailing Address - Fax:317-705-7179
Practice Address - Street 1:8902 N MERIDIAN ST
Practice Address - Street 2:SUITE 230
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5382
Practice Address - Country:US
Practice Address - Phone:317-581-8888
Practice Address - Fax:317-705-7179
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004740A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner