Individual
KENDALL BLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
15725 37TH AVE N STE 1, PLYMOUTH, MN 55446-3206
(612) 446-8474
Mailing address
1206 MISSISSIPPI DR N, CHAMPLIN, MN 55316-2011
(763) 732-8369
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
11206
MN
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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