Individual
ALEXANDRIA DENISE BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
UNIVERSITY OF MINNESOTA PHYSICIANS, 516 DELAWARE STREET SE, PWB FIRST FLOOR, CLINIC 1E, MINNEAPOLIS, MN 55455
(612) 626-6666
Mailing address
UNIVERSITY OF MINNESOTA PHYSICIANS, 420 DELAWARE STREET SE, MMC 195, MINNEAPOLIS, MN 55455
(612) 625-1400
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R 146110-1
MN
363LG0600X
Gerontology Nurse Practitioner
R 146110-1
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-07907
MEDICA CHOICE & PRIMARY
MN
05
—
0599241
—
IA
05
—
083447500
—
MN
01
—
135259
UCARE
MN
01
—
2386128
ARAZ
MN
05
—
4307035
—
MT
01
—
B678
CHAMPUS/TRIWEST
MN
01
—
HP56036
HEALTHPARTNERS
MN
Enumeration date
06/22/2006
Last updated
08/17/2007
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