Individual
CONNIE SUE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CNP
Contact information
Practice address
10081 DOGWOOD ST NW, SUITE 100, COON RAPIDS, MN 55448-5281
(763) 783-3722
(763) 783-7944
Mailing address
10081 DOGWOOD ST NW, SUITE 100, COON RAPIDS, MN 55448-5281
(763) 783-3722
(763) 783-7944
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A0813103
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1203352
MEDICA
MN
05
—
2911984200
—
MN
01
—
31257BL
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/22/2006
Last updated
10/13/2011
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