Provider Demographics
NPI:1326322975
Name:BLOMME, COURTNEY JUNE (APRN, CPNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JUNE
Last Name:BLOMME
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:ST. AUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 MARSH ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 S BRUCE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1934
Practice Address - Country:US
Practice Address - Phone:507-537-9007
Practice Address - Fax:507-537-2720
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP3713363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCNP3713OtherAPRN LICENSE
MNR202004-6OtherRN