Healthcare Provider Details

I. General information

NPI: 1487540126
Provider Name (Legal Business Name): BLAKE WILLIAM LUY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 W 5TH ST
STORM LAKE IA
50588-3000
US

IV. Provider business mailing address

PO BOX 41
EARLY IA
50535-0041
US

V. Phone/Fax

Practice location:
  • Phone: 712-732-6650
  • Fax:
Mailing address:
  • Phone: 712-299-2135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA184884
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: