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NPI Code Detail

MEDICARE: MS. NICOLE AVERIL BLYTHE MSW

MEDICARE: MS. NICOLE AVERIL BLYTHE MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerLW60411039WA

General Provider Information

NPI Number : 1063725372
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE AVERIL BLYTHE MSW
Provider Business Mailing Address
First Line : 2921 NACHES AVE SW
Second Line :
City : RENTON
State : WA
Zip : 98057-2617
Country : US
Telephone Number : 206-630-1680
Fax Number :
Provider Business Practice Location Address
First Line : 2921 NACHES AVE SW
Second Line :
City : RENTON
State : WA
Zip : 98057-2617
Country : US
Telephone Number : 206-630-1380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2010
Last Update Date : 05/13/2022

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