Healthcare Provider Details

I. General information

NPI: 1710362777
Provider Name (Legal Business Name): MINDY MARIE BLODGETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EMILE 42ND ST
OMAHA NE
68198-0001
US

IV. Provider business mailing address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6195
  • Fax: 402-559-9586
Mailing address:
  • Phone: 402-559-6195
  • Fax: 402-559-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111824
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number111824
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: