Elizabeth Miyu Blake, ARNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP30003638 Issued in WA

Practice address

301 N 10TH Ave
Pasco, WA 99301-5480

Phone

(509) 547-2429

NPI assigned

Jul 10, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Elizabeth Larson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1639103237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 WOODLAND AVE",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983685049",
            "telephone_number": "206-422-4035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N 10TH AVE",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993015480",
            "telephone_number": "509-547-2429"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 -- 5th Ave",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "98104",
            "country_code": "US",
            "telephone_number": "206-296-4600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9951 Mickelberry Rd NW",
            "address_2": "Ste 101",
            "address_purpose": "LOCATION",
            "city": "Silverdale",
            "state": "WA",
            "postal_code": "983838309",
            "country_code": "US",
            "telephone_number": "360-692-9362",
            "fax_number": "360-692-6214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "ELIZABETH",
        "middle_name": "MIYU",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "RN00118189",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "AP30003638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARNP LICENSE",
            "identifier": "AP30003638",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9620097",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "RN00118189",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "LARSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chelsea Elizabeth Beveridge, MD
• Andrea Marie Billings, PHARMD
• Terri Binkley, RN
• Rosa Elena Birrueta Mendoza
• Chris Yancey Bjornberg, PT
• Jonathon Wayne Blanchard, ARNP, FNP-C
• Ivana Blaskan, RN
• Blue Sage Adult Family Home LLC
• Body Compass Massage LLC
• Dora Boge, RDH

• Pediatric Nurse Practitioner in Pasco, WA
• Providers in Pasco, WA by specialty
• Pediatric Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.