Provider Demographics
NPI:1073816377
Name:BLESOFF, JAMINE REBECCA (ND)
Entity Type:Individual
Prefix:
First Name:JAMINE
Middle Name:REBECCA
Last Name:BLESOFF
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78193
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-0193
Mailing Address - Country:US
Mailing Address - Phone:206-760-1448
Mailing Address - Fax:206-760-1730
Practice Address - Street 1:4409 50TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1427
Practice Address - Country:US
Practice Address - Phone:206-760-1448
Practice Address - Fax:206-760-1730
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60189964175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath