Individual
BLAKE JOHN BOSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 VETERANS DR, MINNEAPOLIS, MN 55417-2309
(612) 725-2000
Mailing address
468 ROWENA CURV, ELKO NEW MARKET, MN 55054-4710
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2457863
MN
Other
Enumeration date
02/10/2026
Last updated
02/10/2026
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