Provider Demographics
NPI:1780418889
Name:BLYTHER, COLIN D (RN)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:D
Last Name:BLYTHER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 201ST PL SE APT C
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8101
Mailing Address - Country:US
Mailing Address - Phone:404-401-0499
Mailing Address - Fax:
Practice Address - Street 1:1529 201ST PL SE APT C
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-8101
Practice Address - Country:US
Practice Address - Phone:404-401-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60984305163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency