Healthcare Provider Details

I. General information

NPI: 1326322975
Provider Name (Legal Business Name): COURTNEY JUNE BLOMME APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY ST. AUBIN

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BRUCE ST
MARSHALL MN
56258-1934
US

IV. Provider business mailing address

1025 MARSH ST
MANKATO MN
56001-4752
US

V. Phone/Fax

Practice location:
  • Phone: 507-537-9007
  • Fax: 507-537-2720
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP3713
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: