Healthcare Provider Details

I. General information

NPI: 1952638967
Provider Name (Legal Business Name): AIMEE BLOOD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AIMEE REGNIER LPN

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 FRANKLIN ST
GENOA CITY WI
53128-2136
US

IV. Provider business mailing address

407 FRANKLIN ST
GENOA CITY WI
53128-2136
US

V. Phone/Fax

Practice location:
  • Phone: 815-543-9674
  • Fax:
Mailing address:
  • Phone: 815-543-9674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number173289-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number312025031
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: