Individual
BLIA VUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
15800 87TH ST NE, OTSEGO, MN 55330-6546
(866) 389-2727
Mailing address
3016 QUARRY PARK DR APT 3, DE PERE, WI 54115-8195
(920) 716-7561
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
12407
MN
363LF0000X
Family Nurse Practitioner
16000-33
WI
Other
Enumeration date
12/31/2024
Last updated
12/31/2024
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