Individual
THERESA ROSE BLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
300 S BRUCE ST, MARSHALL, MN 56258-1934
(507) 537-9007
(507) 537-2720
Mailing address
300 S BRUCE ST, MARSHALL, MN 56258-1934
(507) 537-9007
(507) 537-2720
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R 088633 4
MN
363LF0000X
Family Nurse Practitioner
Primary
0742
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
816610200
—
MN
Enumeration date
01/09/2006
Last updated
03/09/2015
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