Provider Demographics
NPI:1326791005
Name:BLASINGAME, RACHEL LYNN (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LYNN
Last Name:BLASINGAME
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 S PRIMAVERA DR
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-8000
Mailing Address - Country:US
Mailing Address - Phone:702-569-2636
Mailing Address - Fax:
Practice Address - Street 1:3650 S POINTE CIR STE 101
Practice Address - Street 2:
Practice Address - City:LAUGHLIN
Practice Address - State:NV
Practice Address - Zip Code:89029-0422
Practice Address - Country:US
Practice Address - Phone:702-299-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV832998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily