Individual
MONTANA N BLACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
209 LILLY RD NE, OLYMPIA, WA 98506-5030
(360) 413-8250
(360) 413-8850
Mailing address
7615 TRADITIONS AVE NE, LACEY, WA 98516-1335
(503) 703-7826
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201344
TN
367500000X
Certified Registered Nurse Anesthetist
22155
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
AP60877588
WA
Other
Enumeration date
06/27/2016
Last updated
09/26/2024
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