Healthcare Provider Details

I. General information

NPI: 1528375375
Provider Name (Legal Business Name): CONNIE ROBBINS BLOKKUM CNM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 06/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 AVENUE A
KATY TX
77493-2462
US

IV. Provider business mailing address

1002 AVENUE A
KATY TX
77493-2462
US

V. Phone/Fax

Practice location:
  • Phone: 281-395-6652
  • Fax: 281-391-9081
Mailing address:
  • Phone: 281-395-6652
  • Fax: 281-391-9081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number256351
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number256351
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number256351
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number256351
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: