Healthcare Provider Details

I. General information

NPI: 1285375071
Provider Name (Legal Business Name): BLAKE WADE CHRISTENSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 W DESCHUTES AVE STE B
KENNEWICK WA
99336-7715
US

IV. Provider business mailing address

7211 W DESCHUTES AVE STE B
KENNEWICK WA
99336-7715
US

V. Phone/Fax

Practice location:
  • Phone: 509-221-6930
  • Fax: 509-221-6930
Mailing address:
  • Phone: 509-221-6930
  • Fax: 509-221-6930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDOTP.TO.70134490
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: