Provider Demographics
NPI:1346975208
Name:BLUM, AMY MAY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MAY
Last Name:BLUM
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPWORTH
Mailing Address - State:IA
Mailing Address - Zip Code:52045-9704
Mailing Address - Country:US
Mailing Address - Phone:563-552-9564
Mailing Address - Fax:
Practice Address - Street 1:806 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EPWORTH
Practice Address - State:IA
Practice Address - Zip Code:52045-9704
Practice Address - Country:US
Practice Address - Phone:563-552-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122927163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty