Provider Demographics
NPI:1881366508
Name:BLINN, DAVID LEE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:BLINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 KNOLLWOOD DR UNIT 1105
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1465
Mailing Address - Country:US
Mailing Address - Phone:210-388-7130
Mailing Address - Fax:
Practice Address - Street 1:9200 E PANORAMA CIR STE 160
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3490
Practice Address - Country:US
Practice Address - Phone:970-629-1504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1640574163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse