Provider Demographics
NPI:1184800021
Name:BLAKE, CHRISTINE (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E JEFFERSON ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2477
Mailing Address - Country:US
Mailing Address - Phone:319-339-3672
Mailing Address - Fax:319-358-2737
Practice Address - Street 1:1401 CREES ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52776-1029
Practice Address - Country:US
Practice Address - Phone:319-627-2131
Practice Address - Fax:319-627-2087
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA139948363LF0000X
CT003727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily