Provider Demographics
NPI:1679978332
Name:MYERS, BLAKE M (ND)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:M
Last Name:MYERS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12900 NE 180TH ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5773
Mailing Address - Country:US
Mailing Address - Phone:425-424-2100
Mailing Address - Fax:
Practice Address - Street 1:12900 NE 180TH ST
Practice Address - Street 2:STE. 100
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5773
Practice Address - Country:US
Practice Address - Phone:425-424-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60700466175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath