Provider Demographics
NPI:1275553554
Name:BLASIUS, KARI R (RDLNCDE)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:R
Last Name:BLASIUS
Suffix:
Gender:F
Credentials:RDLNCDE
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:R
Other - Last Name:HAMLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDLNCDE
Mailing Address - Street 1:1000 HEALTH CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:SD
Mailing Address - Zip Code:57752-0540
Mailing Address - Country:US
Mailing Address - Phone:605-455-2451
Mailing Address - Fax:605-455-2808
Practice Address - Street 1:1000 HEALTH CENTER ROAD
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:SD
Practice Address - Zip Code:57752-0540
Practice Address - Country:US
Practice Address - Phone:605-455-8236
Practice Address - Fax:605-455-2808
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD007133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5549010Medicaid
SD5549010Medicaid