Provider Demographics
NPI:1114383916
Name:BLOCKER, JADE
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:BLOCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 183RD ST SE
Mailing Address - Street 2:APT J303
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7495
Mailing Address - Country:US
Mailing Address - Phone:260-701-6252
Mailing Address - Fax:
Practice Address - Street 1:1225 183RD ST SE
Practice Address - Street 2:APT J303
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7495
Practice Address - Country:US
Practice Address - Phone:260-701-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60168671163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator