Provider Demographics
NPI:1083942825
Name:BLANKENSHIP, MICHAEL ALLEN (APRN, PMHNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:APRN, PMHNP
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Mailing Address - Street 1:PO BOX 92900
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10101 SE MAIN ST STE 3001
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2458
Practice Address - Country:US
Practice Address - Phone:503-261-5953
Practice Address - Fax:503-261-5954
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60105167363L00000X
OR200950064NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner