Provider Demographics
NPI:1417169855
Name:BLAUE, BARBARA L (WHNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:BLAUE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:L
Other - Last Name:DIERKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1326 S SERVICE RD W STE 10
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-2306
Mailing Address - Country:US
Mailing Address - Phone:573-468-4455
Mailing Address - Fax:573-468-4451
Practice Address - Street 1:1326 S SERVICE RD W STE 10
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2306
Practice Address - Country:US
Practice Address - Phone:573-468-4455
Practice Address - Fax:573-468-4451
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO065871363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO423917111Medicaid
MOS68956Medicare UPIN
MO152810093Medicare PIN
MO423917111Medicaid