Provider Demographics
NPI:1457305294
Name:BLOME, DOROTHY LINN (MN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:LINN
Last Name:BLOME
Suffix:
Gender:F
Credentials:MN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 FREELAND WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-4929
Mailing Address - Country:US
Mailing Address - Phone:214-321-8750
Mailing Address - Fax:
Practice Address - Street 1:12655 N CENTRAL EXPY
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1700
Practice Address - Country:US
Practice Address - Phone:972-788-1858
Practice Address - Fax:972-288-2798
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219423363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics