Basic Information
| Provider Information | |||||||||
| NPI: | 1932415692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLASKO | ||||||||
| FirstName: | JANET | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5514 160TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980525223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145609305 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 15TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536974000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2010 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH60167254 | WA | N | Pharmacy Service Providers | Pharmacist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | OP60943803 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | PG178225 | 01 | OR | MEDICAL LICENSE # | OTHER |