Individual
MS. ELIZABETH MIYU BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
301 N 10TH AVE, PASCO, WA 99301-5480
(509) 547-2429
Mailing address
128 WOODLAND AVE, PORT TOWNSEND, WA 98368-5049
(206) 422-4035
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP30003638
WA
363LP0200X
Pediatric Nurse Practitioner
RN00118189
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9620097
—
WA
01
—
AP30003638
ARNP LICENSE
WA
01
—
RN00118189
RN LICENSE
WA
Enumeration date
07/10/2006
Last updated
03/07/2023
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