Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | AP61202162 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP61202162 | WA |
NPI | 1376217315 |
---|---|
Provider Name | Mrs. Rosa Maria Blackstone |
First Address | Yakima, WA 98901 |
Second Address | Yakima, WA 98901-9890 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2021 |
Last Update Date | 03/08/2021 |