Provider Demographics
NPI:1437240181
Name:BLANKENSHIP, BETH LORAINE (PA-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:LORAINE
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:509-663-8711
Mailing Address - Fax:
Practice Address - Street 1:505 S 336TH ST STE 500
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8300
Practice Address - Country:US
Practice Address - Phone:206-962-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003496363A00000X
IDPA-233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805151900Medicaid
IDP01532121OtherRAILROAD MEDICARE-IDAHO
000010142568OtherREGENCE BLUESHIELD OF ID
WA8349268Medicaid
PAII3OtherBLUE CROSS OF IDAHO
WAP01566479OtherRAILROAD MEDICARE-WASHINGTON
IDS54555Medicare UPIN
WAP01566479OtherRAILROAD MEDICARE-WASHINGTON
ID805151900Medicaid