Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | MD00041330 | WA |
N | 208000000X | Pediatrician | MD00041330 | WA |
NPI | 1073695227 |
---|---|
Provider Name | Dr. Marie Bleakley |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98105-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 24/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0230825 | L&I (01) | WA |
1073695227 | (05) | WA |
I34371 | (02) |