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Blake Malcolm Ely
Student in an Organized Health Care Education/Training Program in Berea, Ohio
NPI 1013629492

Blake Malcolm Ely is a Student in an Organized Health Care Education/Training Program based in Berea, OH. Blake Malcolm Ely practices in Berea, OH. The NPI Number for Blake Malcolm Ely is 1013629492 and holds a License No. 390200000X (Ohio).

The current practice location address for Blake Malcolm Ely is 275 Eastland Rd, Berea, OH and can be reached out via phone at 440-826-8012.

Location: 275 Eastland Rd, Berea, OH, 44017-2005
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1013629492
Provider Name
Blake Malcolm Ely
Credential
Provider Entity Type
Individual
Gender
Male
Address
275 Eastland Rd, Berea, OH, 44017-2005
Phone Number
440-826-8012
Fax Number
Provider Enumeration Date
12/19/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
275 Eastland Rd
City
Berea
State
Ohio
Zip
44017-2005
Phone Number
440-826-8012
Fax Number
person
Provider Business Mailing Address Details
Address
275 Eastland Rd
City
Berea
State
Ohio
Zip
44017-2005
Phone Number
440-826-8012
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
390200000X (Ohio)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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