BLAKE MCCONNELL (NPI# 1063074789) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1063074789 |
Entity Type | Individual |
Full Name | BLAKE MCCONNELL |
Practice Address |
4855 Sw Western Ave Beaverton OR 97005-3460 |
Mailing Address |
3181 Sw Sam Jackson Park Rd Portland OR 97239-3011 |
Practice Telephone | 8008132000 |
Enumeration Date | 2019-07-02 |
Last Update Date | 2019-07-02 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
Street Address |
4855 SW WESTERN AVE |
City | BEAVERTON |
State | OR |
Zip Code | 97005-3460 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407827694 | Jennifer Mae Soyke | Family Medicine | 4855 Sw Western Ave, University of Oregon, Beaverton, OR 97005-3460 | 2006-01-27 |
1043857105 | Reagan Ravanzo Blanco | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-12-06 |
1144866591 | Asela Agtay Wells | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-11-20 |
1851935969 | Rosilyn Ricard | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-10-31 |
1154886877 | Sarah Elizabeth Anderson Mills | Dental Assistant | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2019-02-06 |
1023506219 | Amanda Ellen Koonce | Student in an Organized Health Care Education/Training Program | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2018-04-24 |
1285142802 | Tiffani O'neill | Counselor | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2018-01-17 |
1912438953 | Dia Hazra | Pediatrics | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2017-03-22 |
1346782794 | Nicole Pollock | Pharmacist | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2016-11-15 |
1083166219 | Kaiser Foundation Health Plan of The Northwest | Dentist | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2016-11-04 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
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Taxonomy Code | 390200000X |
Grouping | Student, Health Care |
Classification | Student in an Organized Health Care Education/Training Program |
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
Notes: [1/1/2005: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
1215557269 | Kara Webster | Student in an Organized Health Care Education/Training Program | 20894 Sw Eggert Way, Beaverton, OR 97078-2162 | 2020-04-20 |
1336777671 | Yuan Qu | Student in an Organized Health Care Education/Training Program | 16904 Sw Lemongrass Ln, Beaverton, OR 97007-2017 | 2020-03-31 |
1265065395 | Davis Lehman | Student in an Organized Health Care Education/Training Program | 4200 Sw 107th Ave Apt 703, Beaverton, OR 97005-3140 | 2020-02-18 |
1316404361 | Lauren Taylor Garcia | Student in an Organized Health Care Education/Training Program | 4490 Sw Mueller Dr Apt L304, Beaverton, OR 97078-8054 | 2019-02-26 |
1255898375 | Michael R.r. Fanning | Student in an Organized Health Care Education/Training Program | 722 Sw Sosa Pl, Beaverton, OR 97003-1643 | 2019-02-25 |
1740660372 | Kevin Yeo | Student in an Organized Health Care Education/Training Program | 14110 Sw Allen Blvd Apt 91, Beaverton, OR 97005-4702 | 2015-06-09 |
1598145682 | Allyson Burk | Student in an Organized Health Care Education/Training Program | 8339 Sw Shawmut Dr, Beaverton, OR 97007-8593 | 2015-06-03 |
1346488434 | Ying Zhang | Student in an Organized Health Care Education/Training Program | 16709 Nw Paisley Dr, Beaverton, OR 97006 | 2009-01-27 |
1669096509 | Alina Grimsted | Student in an Organized Health Care Education/Training Program | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-06-06 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.