Provider Demographics
NPI:1073049706
Name:BLACKMAN, WENDY (DNP, ARNP, CPNP-PC)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:DNP, ARNP, CPNP-PC
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:FAIRALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, ARNP, CPNP-PC
Mailing Address - Street 1:3516 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5218
Mailing Address - Country:US
Mailing Address - Phone:360-456-1600
Mailing Address - Fax:
Practice Address - Street 1:3516 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5218
Practice Address - Country:US
Practice Address - Phone:360-456-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046292363LP0200X
WAAP60755101363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics