Individual
AMANDA SUE BLONIGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
106 4TH AVE N., FERGUS FALLS, MN 56537-1034
(218) 998-3778
Mailing address
3332 OAK STREET, APT. G, BRAINERD, MN 56401
(320) 491-4984
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L69547-3
MN
Other
Enumeration date
07/02/2010
Last updated
07/02/2010
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