Provider Demographics
NPI:1063255719
Name:BLASKAN, IVANA (RN)
Entity type:Individual
Prefix:
First Name:IVANA
Middle Name:
Last Name:BLASKAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 HUDSON DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6719
Mailing Address - Country:US
Mailing Address - Phone:509-591-1328
Mailing Address - Fax:
Practice Address - Street 1:8120 HUDSON DR
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-6719
Practice Address - Country:US
Practice Address - Phone:509-591-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60222035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty