Healthcare Provider Details

I. General information

NPI: 1265641575
Provider Name (Legal Business Name): PATRICIA BLAINE L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10137 MAIN ST STE 5
BOTHELL WA
98011-3443
US

IV. Provider business mailing address

13527 N PARK AVE N
SEATTLE WA
98133-7426
US

V. Phone/Fax

Practice location:
  • Phone: 425-483-0129
  • Fax:
Mailing address:
  • Phone: 425-483-0129
  • Fax: 206-368-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000235
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: