Provider Demographics
NPI:1760106827
Name:BLISSETT, LATWANYA
Entity Type:Individual
Prefix:
First Name:LATWANYA
Middle Name:
Last Name:BLISSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 WASHINGTON AVE UNIT 611
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1968
Mailing Address - Country:US
Mailing Address - Phone:605-415-1827
Mailing Address - Fax:
Practice Address - Street 1:6190 TERRACE VIEW LN SE APT E108
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-5552
Practice Address - Country:US
Practice Address - Phone:314-333-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health Worker