Healthcare Provider Details

I. General information

NPI: 1669014593
Provider Name (Legal Business Name): NEIDA L. BLONDET MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 N FILLMORE ST SUITE 100
COLORADO SPRINGS CO
80907-6464
US

IV. Provider business mailing address

1380 N FILLMORE ST SUITE 100
COLORADO SPRINGS CO
80907-6464
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-1006
  • Fax: 719-630-0688
Mailing address:
  • Phone: 719-630-1006
  • Fax: 719-630-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11004553
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0001783-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: