Healthcare Provider Details

I. General information

NPI: 1184271322
Provider Name (Legal Business Name): JOANNA BLONDEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 4TH AVE NW
MINOT ND
58703-3069
US

IV. Provider business mailing address

13 OLIVE TREE CIR NE
MINOT ND
58703-2514
US

V. Phone/Fax

Practice location:
  • Phone: 503-481-4730
  • Fax: 701-707-3834
Mailing address:
  • Phone: 503-481-4730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR55036
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: