Provider Demographics
NPI:1013728344
Name:BLOMENBERG, ALLEGRA (PA)
Entity type:Individual
Prefix:
First Name:ALLEGRA
Middle Name:
Last Name:BLOMENBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 WESTGATE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2571
Mailing Address - Country:US
Mailing Address - Phone:253-752-8882
Mailing Address - Fax:253-752-8907
Practice Address - Street 1:6002 WESTGATE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2571
Practice Address - Country:US
Practice Address - Phone:253-752-8882
Practice Address - Fax:253-752-8907
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61657251363AM0700X, 363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical