Provider Demographics
NPI:1679218994
Name:BLUM, MEGHAN LYN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:LYN
Last Name:BLUM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 JONATHON DAYTON WAY
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8269
Mailing Address - Country:US
Mailing Address - Phone:937-407-1396
Mailing Address - Fax:
Practice Address - Street 1:5920 WILCOX PL STE D
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-6802
Practice Address - Country:US
Practice Address - Phone:614-389-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner