Provider Demographics
NPI:1114738127
Name:BLANTON, ROCHELLE J (NP)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:J
Last Name:BLANTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:J
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11208 NE 269TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-6517
Mailing Address - Country:US
Mailing Address - Phone:360-723-0528
Mailing Address - Fax:
Practice Address - Street 1:101 NW 12TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9141
Practice Address - Country:US
Practice Address - Phone:360-723-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61650657363L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine