Provider Demographics
NPI:1811962442
Name:BLIEK, REESE J (PA)
Entity type:Individual
Prefix:MR
First Name:REESE
Middle Name:J
Last Name:BLIEK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:275 SE CABOT DR STE A3
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3740
Mailing Address - Country:US
Mailing Address - Phone:360-682-5024
Mailing Address - Fax:360-682-5749
Practice Address - Street 1:275 SE CABOT DR STE A3
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3740
Practice Address - Country:US
Practice Address - Phone:360-720-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004653363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAVAD000Medicare UPIN