Healthcare Provider Details

I. General information

NPI: 1427730969
Provider Name (Legal Business Name): ALLY KATHRYN BLAESER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8373 UNITY DRIVE
MOUNTAIN IRON MN
55768
US

IV. Provider business mailing address

8373 UNITY DRIVE
MOUNTAIN IRON MN
55768
US

V. Phone/Fax

Practice location:
  • Phone: 218-748-7480
  • Fax:
Mailing address:
  • Phone: 218-748-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10530
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: