Healthcare Provider Details

I. General information

NPI: 1043466246
Provider Name (Legal Business Name): OPHELIA I BLUE R.N., N.P., C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 25TH AVE NE # 475
SEATTLE WA
98105-4183
US

IV. Provider business mailing address

4616 25TH AVE NE # 475
SEATTLE WA
98105-4183
US

V. Phone/Fax

Practice location:
  • Phone: 206-401-8411
  • Fax: 206-480-0986
Mailing address:
  • Phone: 206-401-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPF18319
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP023760
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60321916
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCNS3003
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCNS000331
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60321915
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN732316
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN682919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: