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General NPI Number Information
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NPI Number | 1336735273
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Entity Type | Individual
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Provider Name | HELAINE SUE BLOMENKAMP FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 4107 S WATER TOWER PL
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City | MOUNT VERNON
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State | IL
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Zip | 62864-6784
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Country | US
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Telephone | 618-244-0031
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Fax |
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Provider Business Mailing Address
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Address Line | 4107 S WATER TOWER PL
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City | MOUNT VERNON
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State | IL
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Zip | 62864-6784
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Country | US
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Telephone | 618-244-0031
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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 | 2020041032
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209022542
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License Number State | IL
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