Provider Demographics
NPI:1588026009
Name:BLUMENSHINE, TARA (APRN, CNM FNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BLUMENSHINE
Suffix:
Gender:F
Credentials:APRN, CNM FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4452
Mailing Address - Country:US
Mailing Address - Phone:307-463-0541
Mailing Address - Fax:307-630-5414
Practice Address - Street 1:705 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4452
Practice Address - Country:US
Practice Address - Phone:307-463-0541
Practice Address - Fax:307-463-0541
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1505363LF0000X
WY28234-1505367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife