Provider Demographics
NPI:1275949174
Name:BLOMQUIST, MAUREEN (NP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BLOMQUIST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2299
Mailing Address - Country:US
Mailing Address - Phone:702-293-4111
Mailing Address - Fax:702-293-0430
Practice Address - Street 1:999 ADAMS BLVD STE 104-105
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2244
Practice Address - Country:US
Practice Address - Phone:702-698-8342
Practice Address - Fax:702-293-2807
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV858118363LP0200X
CA95007153363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics