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General NPI Number Information
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NPI Number | 1588026009
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Entity Type | Individual
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Provider Name | TARA BLUMENSHINE APRN, CNM FNP
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Gender | Female
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 705 E WASHINGTON AVE
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City | RIVERTON
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State | WY
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Zip | 82501-4452
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Country | US
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Telephone | 307-463-0541
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Fax | 307-463-0541
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Provider Business Mailing Address
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Address Line | 705 E WASHINGTON AVE
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City | RIVERTON
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State | WY
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Zip | 82501-4452
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Country | US
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Telephone | 307-463-0541
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Fax | 307-630-5414
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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 | 1505
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 28234-1505
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License Number State | WY
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