Provider Demographics
NPI:1568145670
Name:BLAKELY, ANN MARIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3652
Mailing Address - Country:US
Mailing Address - Phone:308-530-8013
Mailing Address - Fax:308-535-7111
Practice Address - Street 1:1220 W 2ND ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3652
Practice Address - Country:US
Practice Address - Phone:308-530-7105
Practice Address - Fax:308-535-7111
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE61532163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse