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General NPI Number Information
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NPI Number | 1508103086
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Entity Type | Individual
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Provider Name | JOHNIE LYNN BLUM FNP
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Gender | Female
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 8340 SANGRE DE CRISTO RD STE 202
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City | LITTLETON
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State | CO
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Zip | 80127-4252
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Country | US
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Telephone | 970-424-9793
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Fax | 970-788-7334
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Provider Business Mailing Address
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Address Line | 5695 INDIAN PAINT RUN
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City | LITTLETON
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State | CO
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Zip | 80125-9235
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Country | US
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Telephone | 970-424-9793
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Fax | 970-788-7334
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN164104
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License Number State | AZ
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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 | TAP8497
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP8497
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0994288-NP
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License Number State | CO
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