Healthcare Provider Details

I. General information

NPI: 1821933268
Provider Name (Legal Business Name): KATELYN MARIE BLONSKI RN, LSN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5061 MINNESOTA ST SE
PRIOR LAKE MN
55372-2574
US

IV. Provider business mailing address

5061 MINNESOTA ST SE
PRIOR LAKE MN
55372-2574
US

V. Phone/Fax

Practice location:
  • Phone: 952-226-0000
  • Fax:
Mailing address:
  • Phone: 952-226-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1911004
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: