Provider Demographics
NPI:1609082866
Name:BLEVINS, ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16045 1ST AVE S FL 2
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1401
Mailing Address - Country:US
Mailing Address - Phone:206-965-4200
Mailing Address - Fax:253-985-6879
Practice Address - Street 1:16045 1ST AVE S FL 2
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1401
Practice Address - Country:US
Practice Address - Phone:206-965-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186040207V00000X
WAMD60085555207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2002905Medicaid