Provider Demographics
NPI:1275204109
Name:BLINDAUER, LUDMILA
Entity Type:Individual
Prefix:
First Name:LUDMILA
Middle Name:
Last Name:BLINDAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MILLA
Other - Middle Name:
Other - Last Name:BLINDAUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD(DONA)
Mailing Address - Street 1:4811 152ND ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-8823
Mailing Address - Country:US
Mailing Address - Phone:206-930-3917
Mailing Address - Fax:
Practice Address - Street 1:4811 152ND ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-8823
Practice Address - Country:US
Practice Address - Phone:206-930-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA13846374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA99499Medicaid