Healthcare Provider Details

I. General information

NPI: 1184433682
Provider Name (Legal Business Name): BLIA VUE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 87TH ST NE
OTSEGO MN
55330-6546
US

IV. Provider business mailing address

3016 QUARRY PARK DR APT 3
DE PERE WI
54115-8195
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 920-716-7561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16000-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12407
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: