Provider Demographics
NPI:1174024939
Name:BLOUIR, CAROLYN MAE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MAE
Last Name:BLOUIR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 ARBOR BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-4298
Mailing Address - Country:US
Mailing Address - Phone:219-947-6920
Mailing Address - Fax:219-947-6921
Practice Address - Street 1:3545 ARBOR BLVD STE E
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4298
Practice Address - Country:US
Practice Address - Phone:219-947-6920
Practice Address - Fax:219-947-6921
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007816A363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001565128OtherANTHEM
IN300012968Medicaid