Provider Demographics
NPI:1265681571
Name:BLOCK, JANNA LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JANNA
Middle Name:LYNN
Last Name:BLOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:LYNN
Other - Last Name:FULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:115 10TH AVE NE STE A
Mailing Address - Street 2:ESSENTIA HEALTH DEER RIVER CLINIC
Mailing Address - City:DEER RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:56636-8795
Mailing Address - Country:US
Mailing Address - Phone:218-246-8275
Mailing Address - Fax:
Practice Address - Street 1:115 10TH AVE NE STE A
Practice Address - Street 2:ESSENTIA HEALTH DEER RIVER CLINIC
Practice Address - City:DEER RIVER
Practice Address - State:MN
Practice Address - Zip Code:56636-8795
Practice Address - Country:US
Practice Address - Phone:218-246-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 164438-4363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily