Provider Demographics
NPI:1568658797
Name:BIANCONI, EMILY A K (FNP)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:A K
Last Name:BIANCONI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:A
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2101 LITTLE MOUNTAIN LANE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274
Mailing Address - Country:US
Mailing Address - Phone:360-542-1362
Mailing Address - Fax:360-428-3941
Practice Address - Street 1:2101 LITTLE MOUNTAIN LANE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274
Practice Address - Country:US
Practice Address - Phone:360-542-1362
Practice Address - Fax:360-428-3941
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266629363LF0000X
WAAP 60136899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2017301Medicaid