Individual
JODEE L BLAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
737 BROADWAY N, FARGO, ND 58102-4421
(701) 234-6258
Mailing address
737 BROADWAY N, FARGO, ND 58102-4421
(701) 234-6258
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
R 152598-2
MN
367500000X
Certified Registered Nurse Anesthetist
Primary
R34791
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093955593
—
MN
01
—
P00733656
MEDICARE RAILROAD
MN
Enumeration date
02/24/2009
Last updated
02/22/2010
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