Provider Demographics
NPI:1043466246
Name:BLUE, OPHELIA I (RN, NP, CNS)
Entity Type:Individual
Prefix:
First Name:OPHELIA
Middle Name:I
Last Name:BLUE
Suffix:
Gender:F
Credentials:RN, NP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 25TH AVE NE # 475
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4183
Mailing Address - Country:US
Mailing Address - Phone:206-401-8411
Mailing Address - Fax:
Practice Address - Street 1:4616 25TH AVE NE # 475
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4183
Practice Address - Country:US
Practice Address - Phone:206-401-8411
Practice Address - Fax:206-480-0986
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60321915163W00000X
PARN732316163W00000X
CARN682919163W00000X
CANPF18319363L00000X
PASP023760363L00000X
CACNS3003364S00000X
PACNS000331364S00000X
WAAP60321916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFA112XOtherMEDICARE PTAN (PROVIDER TRANSACTION ACCESS NUMBER) FA112X