Individual
ANNIKA LEE BLAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 UNIVERSITY AVE W, SAINT PAUL, MN 55104-3727
(612) 232-2002
Mailing address
1619 OAKBROOKE DR, EAGAN, MN 55122-4205
(612) 226-3385
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1991914
MN
363LA2200X
Adult Health Nurse Practitioner
6070
MN
363LG0600X
Gerontology Nurse Practitioner
Primary
6070
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1991914
RN LICENSE
MN
01
—
241607
RN LICENSE
WI
01
—
6070
CERTIFIED NURSE PRACTITIONER LICENSE
MN
Enumeration date
08/02/2018
Last updated
11/25/2018
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