Provider Demographics
NPI:1174144224
Name:BLAKENEY, JOSIE
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:BLAKENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 NW UNIVERSITY PL APT 6
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6608
Mailing Address - Country:US
Mailing Address - Phone:662-541-2674
Mailing Address - Fax:
Practice Address - Street 1:4560 NW UNIVERSITY PL APT 6
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6608
Practice Address - Country:US
Practice Address - Phone:662-541-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000004264374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000004264Medicaid