Provider Demographics
NPI:1972729903
Name:BLUM, JOAN MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:BLUM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDMUNDSON PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4658
Mailing Address - Country:US
Mailing Address - Phone:712-322-4136
Mailing Address - Fax:712-322-8129
Practice Address - Street 1:1 EDMUNDSON PL
Practice Address - Street 2:SUITE 100
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4658
Practice Address - Country:US
Practice Address - Phone:712-322-4136
Practice Address - Fax:712-322-8129
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA065359174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist