MEDICARE: AIMEE BLOOD RN

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	164W00000X	Licensed Practical Nurse	312025031	WI
2	163W00000X	Registered Nurse	173289-30	WI

General Provider Information

NPI Number	:	1952638967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE BLOOD RN

Provider Business Mailing Address
First Line	:	407 FRANKLIN ST
Second Line	:
City	:	GENOA CITY
State	:	WI
Zip	:	53128-2136
Country	:	US
Telephone Number	:	815-543-9674
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 FRANKLIN ST
Second Line	:
City	:	GENOA CITY
State	:	WI
Zip	:	53128-2136
Country	:	US
Telephone Number	:	815-543-9674
Fax Number	:

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

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	06/21/2010

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