NPI 1013643048

Blake Wollam

Practitioner Family Nurse Practitioner Mentor, OH

Practice location

Address: 7060 Wayside Dr, Mentor, OH 44060-6527
Phone: (440) 357-2770
Mailing address: 2157 Lakeland Ave, Lakewood, OH 44107-5715

Registered specialties

Family Nurse Practitioner Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LF0000X Licence APRN.CNP.0031396 (OH)

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Registry record

NPI: 1013643048
Entity type: Individual
Sex (as registered): Male
NPI issued: 1 Aug 2022
Record last updated: 1 Aug 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.