Provider Demographics
NPI:1063427763
Name:BLAKESLEE, ANNETTE DOROTHY (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:DOROTHY
Last Name:BLAKESLEE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 VIENNA PL
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20189-9900
Mailing Address - Country:US
Mailing Address - Phone:431-320-0367
Mailing Address - Fax:131-339-2915
Practice Address - Street 1:9900 VIENNA PL
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20189-9900
Practice Address - Country:US
Practice Address - Phone:431-320-0367
Practice Address - Fax:131-339-2915
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX502428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily