1437240181 NPI number — BETH LORAINE BLANKENSHIP PA-C

Table of content: BETH LORAINE BLANKENSHIP PA-C (NPI 1437240181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437240181 NPI number — BETH LORAINE BLANKENSHIP PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANKENSHIP
Provider First Name:
BETH
Provider Middle Name:
LORAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437240181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 N CHELAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENATCHEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98801-2028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-663-8711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 S 336TH ST STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-962-3535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA10003496 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA-233 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 805151900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01532121 . This is a "RAILROAD MEDICARE-IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010142568 . This is a "REGENCE BLUESHIELD OF ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8349268 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PAII3 . This is a "BLUE CROSS OF IDAHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01566479 . This is a "RAILROAD MEDICARE-WASHINGTON" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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