Provider Demographics
NPI:1578974010
Name:BLUMREICH, JUSTIN C (APRN)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:C
Last Name:BLUMREICH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2321
Mailing Address - Country:US
Mailing Address - Phone:785-408-5800
Mailing Address - Fax:785-730-8700
Practice Address - Street 1:2107 AIRPARK DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2433
Practice Address - Country:US
Practice Address - Phone:530-241-1111
Practice Address - Fax:530-241-4870
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76450363L00000X
CA95009002363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002275OtherMEDICARE PTAN
KS201102780AMedicaid