Provider Demographics
NPI:1376318592
Name:BLETH, RENAE MARIE
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:MARIE
Last Name:BLETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:NEW SALEM
Mailing Address - State:ND
Mailing Address - Zip Code:58563-0187
Mailing Address - Country:US
Mailing Address - Phone:701-400-0837
Mailing Address - Fax:
Practice Address - Street 1:4619 CO RD 139
Practice Address - Street 2:
Practice Address - City:NEW SALEM
Practice Address - State:ND
Practice Address - Zip Code:58563-5856
Practice Address - Country:US
Practice Address - Phone:701-400-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant