Basic Information
| Provider Information | |||||||||
| NPI: | 1699087866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANKENHEIM | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10452 SILVERDALE WAY NW | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983839460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603077300 | ||||||||
| FaxNumber: | 3603077304 | ||||||||
| Practice Location | |||||||||
| Address1: | 10452 SILVERDALE WAY NW | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983839411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603077300 | ||||||||
| FaxNumber: | 3603077304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2010 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA60270946 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 2571-23 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | PA60270946 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.