Blake, Danielle Renae

Blake, Danielle Renae is an sole proprietor health care provider with primary practice located at 5020 N Illinois St , Fairview Heights IL 62208-3411. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Blake, Danielle Renae can be contacted via phone (618) 222-8900.

Contact Information

Primary practice address
5020 N Illinois St Fairview Heights IL 62208-3411
Phone: (618) 222-8900
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209021461 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2020019717 Missouri

Profile Details

NPI number 1295353308
LBN Legal business name Blake, Danielle Renae
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 7th, 2020
Last updated Feb 10th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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