Provider Demographics
NPI:1528375375
Name:BLOKKUM, CONNIE ROBBINS (CNM, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:ROBBINS
Last Name:BLOKKUM
Suffix:
Gender:F
Credentials:CNM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2462
Mailing Address - Country:US
Mailing Address - Phone:281-395-6652
Mailing Address - Fax:281-391-9081
Practice Address - Street 1:1002 AVENUE A
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2462
Practice Address - Country:US
Practice Address - Phone:281-395-6652
Practice Address - Fax:281-391-9081
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2012-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256351163WL0100X, 363LW0102X, 363LX0001X, 367A00000X
TX374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty