BLAKE MCCONNELL


Address: 4855 Sw Western Ave, Beaverton, OR 97005-3460
Phone: 8008132000

BLAKE MCCONNELL (NPI# 1063074789) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 390200000X Student in an Organized Health Care Education/Training Program Student, Health Care

Office Location

Street Address 4855 SW WESTERN AVE
City BEAVERTON
State OR
Zip Code 97005-3460

Providers in the same location

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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Providers in the same zip code

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 Information

Taxonomy Code 390200000X
Grouping Student, Health Care
Classification Student in an Organized Health Care Education/Training Program

Taxonomy Definition

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]

Providers in the same taxonomy and city

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
Find all providers in BEAVERTON

Competitor

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City BEAVERTON
Zip Code 97005

Improve Information

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Dataset Information

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.

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