Provider Demographics
NPI:1508103086
Name:BLUM, JOHNIE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:JOHNIE
Middle Name:LYNN
Last Name:BLUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5695 INDIAN PAINT RUN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-9235
Mailing Address - Country:US
Mailing Address - Phone:970-424-9793
Mailing Address - Fax:970-788-7334
Practice Address - Street 1:8340 SANGRE DE CRISTO RD STE 202
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4252
Practice Address - Country:US
Practice Address - Phone:970-424-9793
Practice Address - Fax:970-788-7334
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN164104163W00000X
AZTAP8497363LF0000X
AZAP8497363LF0000X
CO0994288-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse