Blake, Sally S

Blake, Sally S is an individual health care provider with primary practice located at 2319 Saint Matthews Rd , Orangeburg SC 29118. 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, Sally S can be contacted via phone (803) 536-1571.

Contact Information

Primary practice address
2319 Saint Matthews Rd Orangeburg SC 29118
Phone: (803) 536-1571
Fax: (803) 534-3860
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 710 South Carolina

Profile Details

NPI number 1750432985
LBN Legal business name Blake, Sally S
Credentials FNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 15th, 2007
Last updated Feb 11th, 2019 - about 6 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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Identifiers

StateTypeNumberIssuer
All States NPI 1750432985 NPPES
South Carolina Other 710 STATE LICENSE #
South Carolina MEDICAID NP1060 STATE LICENSE #
South Carolina Other F710 STATE LICENSE #

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