Provider Demographics
NPI:1750688578
Name:BLAKE, MARGARET MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:MARIE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E 241ST ST
Mailing Address - Street 2:1 ST FL.
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1005
Mailing Address - Country:US
Mailing Address - Phone:646-831-5581
Mailing Address - Fax:
Practice Address - Street 1:603 E 241ST ST
Practice Address - Street 2:1 ST FL.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1005
Practice Address - Country:US
Practice Address - Phone:646-831-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282749-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse