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General NPI Number Information
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NPI Number | 1477955979
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Entity Type | Individual
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Provider Name | COURTNEY BLOMME RD
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Gender | Female
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 1675 HIGHLAND AVE
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City | MADISON
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State | WI
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Zip | 53792-0002
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Country | US
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Telephone | 608-890-5297
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 HIGHLAND AVE MAIL CODE: 1510
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City | MADISON
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State | WI
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Zip | 53792-0002
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Country | US
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Telephone |
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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 | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | 2758-029
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License Number State | WI
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