Provider Demographics
NPI:1457547325
Name:ALI, BLISS CASTELLANO (ARNP, CNM)
Entity Type:Individual
Prefix:
First Name:BLISS
Middle Name:CASTELLANO
Last Name:ALI
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 NW 198TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2339
Mailing Address - Country:US
Mailing Address - Phone:206-406-6048
Mailing Address - Fax:
Practice Address - Street 1:2120 NW 198TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2339
Practice Address - Country:US
Practice Address - Phone:206-406-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007569367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife