Provider Demographics
NPI:1467470674
Name:BLUE, PATRICIA ELENA (CNM)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELENA
Last Name:BLUE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ELENA
Other - Last Name:KELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:924 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5441
Mailing Address - Country:US
Mailing Address - Phone:507-333-3300
Mailing Address - Fax:507-333-3214
Practice Address - Street 1:924 1ST ST NE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5441
Practice Address - Country:US
Practice Address - Phone:507-333-3300
Practice Address - Fax:507-333-3214
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1494013367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN968108600Medicaid
S28526Medicare UPIN
MN420000488Medicare ID - Type Unspecified