Provider Demographics
NPI:1265641575
Name:BLAINE, PATRICIA (LAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BLAINE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13527 N PARK AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7426
Mailing Address - Country:US
Mailing Address - Phone:425-483-0129
Mailing Address - Fax:206-368-8915
Practice Address - Street 1:10137 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3443
Practice Address - Country:US
Practice Address - Phone:425-483-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist