Provider Demographics
NPI:1154074979
Name:BLUE NILE SERVICES COMPANY LLC
Entity Type:Organization
Organization Name:BLUE NILE SERVICES COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELRAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-319-7457
Mailing Address - Street 1:140 BEACH LAKE RD SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-4172
Mailing Address - Country:US
Mailing Address - Phone:507-319-7457
Mailing Address - Fax:
Practice Address - Street 1:140 BEACH LAKE RD SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4172
Practice Address - Country:US
Practice Address - Phone:507-319-7457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care