Provider Demographics
NPI:1730313057
Name:BLUTHARDT, DIANA LYN (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYN
Last Name:BLUTHARDT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYN
Other - Last Name:FECZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 ANNANDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55302-3141
Mailing Address - Country:US
Mailing Address - Phone:651-259-3865
Mailing Address - Fax:
Practice Address - Street 1:UNIT 33100
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180-3100
Practice Address - Country:US
Practice Address - Phone:314-590-8298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 144367-9363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health