Basic Information
| Provider Information | |||||||||
| NPI: | 1609082866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLEVINS | ||||||||
| FirstName: | ANNETTE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16045 1ST AVE S FL 2 | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981481401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069654200 | ||||||||
| FaxNumber: | 2539856879 | ||||||||
| Practice Location | |||||||||
| Address1: | 16045 1ST AVE S FL 2 | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981481401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069654200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MT186040 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD60085555 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2002905 | 05 | WA | MEDICAID |