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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

WANDA BLAKE

Active Sole Proprietor

WANDA BLAKE is a 2278G1100X healthcare provider located in DALLAS, Texas. NPI 1962888297 is currently active in the NPPES registry. Verify at CMS.

2278G1100X · DALLAS, TX

Registration Details

NPI Number
1962888297
Provider Type
Individual
Gender
Female
NPI Issued
Aug 10, 2015 (11.047029649019 yrs)
Last Updated
Aug 10, 2015
License
62660 (TX)
Sole Proprietor
Yes

Practice Information

Address
4300 ROSEMEADE PKWY APT 812
DALLAS, TX, 752872921
Browse TX providers · Browse ZIP 75287
Phone
2142830892
Primary Specialty
2278G1100X
2278G1100X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.