Healthcare Provider Details

I. General information

NPI: 1861353914
Provider Name (Legal Business Name): JUSTIN BLATNIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 2ND ST SW
ROCHESTER MN
55902-1906
US

IV. Provider business mailing address

605 BOULDER RD SE
ROCHESTER MN
55904-7003
US

V. Phone/Fax

Practice location:
  • Phone: 507-225-5123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2492226
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: