Individual
DIANNE EILEEN BLUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1185 S ELM ST, CANBY, OR 97013-3935
(503) 723-4670
(503) 266-6649
Mailing address
6 CENTERPOINTE DR, STE 200, LAKE OSWEGO, OR 97035-8653
(503) 797-2268
(503) 234-8227
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
200150096
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275246
—
OR
Enumeration date
05/23/2005
Last updated
10/18/2010
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