MEDICARE: ANNA BLONQUIST NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	25763	ID

General Provider Information

NPI Number	:	1922641968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA BLONQUIST NP-C

Provider Business Mailing Address
First Line	:	PO BOX 742358
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 E 25TH ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7542
Country	:	US
Telephone Number	:	208-227-2100
Fax Number	:	208-227-2362

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	02/06/2026

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