Provider Demographics
NPI:1134945157
Name:BLAKE, ALISHA (BSN-RN-PHN)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:BSN-RN-PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 17TH AVE E APT 105
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5205
Mailing Address - Country:US
Mailing Address - Phone:415-867-2289
Mailing Address - Fax:
Practice Address - Street 1:5410 NE WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2161
Practice Address - Country:US
Practice Address - Phone:415-867-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61550303163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty