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Individual
DEBORAH DENISE BLAKELY
Active
Individual
DEBORAH DENISE BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2064
SC
363AM0700X
Medical Physician Assistant
PA10004719
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8410078
—
WA
Enumeration date
05/19/2006
Last updated
12/05/2017
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