MEDICARE: MRS. BECKY JEAN PRIDEAUX BLODGETT ARNP

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
1	363L00000X	Nurse Practitioner	RN00089325	WA
2	363L00000X	Nurse Practitioner	AP30003968	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CO3401	OTHER	WA	MEDICARE OTHER-GROUP
4	500004687	OTHER	WA	MEDICARE OTHER-INDIVIDUAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP30003968	OTHER	WA	LICENSE
2	RN00089325	OTHER	WA	LICENSE

General Provider Information

NPI Number	:	1942274204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BECKY JEAN PRIDEAUX BLODGETT ARNP

Provider Business Mailing Address
First Line	:	7808 PACIFIC AVE STE 3
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98408-7039
Country	:	US
Telephone Number	:	253-503-6178
Fax Number	:	253-240-0587

Provider Business Practice Location Address
First Line	:	7808 PACIFIC AVE STE 3
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98408-7039
Country	:	US
Telephone Number	:	253-503-6178
Fax Number	:	253-240-0587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/18/2019

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Directions to “ MRS. BECKY JEAN PRIDEAUX BLODGETT ARNP” Practice Location

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