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General NPI Number Information
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NPI Number | 1184433682
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Entity Type | Individual
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Provider Name | BLIA VUE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 15800 87TH ST NE
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City | OTSEGO
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State | MN
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Zip | 55330-6546
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 3016 QUARRY PARK DR APT 3
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City | DE PERE
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State | WI
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Zip | 54115-8195
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Country | US
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Telephone | 920-716-7561
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 16000-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 12407
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License Number State | MN
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