Provider Demographics
NPI:1891349841
Name:KOVNER, BLAKE ASHLEY (ND)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ASHLEY
Last Name:KOVNER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 REYNOLDA VLG STE B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5148
Mailing Address - Country:US
Mailing Address - Phone:336-724-4452
Mailing Address - Fax:
Practice Address - Street 1:117 REYNOLDA VLG STE B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5148
Practice Address - Country:US
Practice Address - Phone:336-724-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60932107175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty