Healthcare Provider Details

I. General information

NPI: 1407696784
Provider Name (Legal Business Name): ALEXIS BLAND PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS BLAND

II. Dates (important events)

Enumeration Date: 05/25/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N CHELAN AVE
WENATCHEE WA
98801-2028
US

IV. Provider business mailing address

820 N CHELAN AVE
WENATCHEE WA
98801-2028
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-1511
  • Fax:
Mailing address:
  • Phone: 509-663-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.PA.70175244
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: