Stephanie Renee Blum, FNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

AP60071587 Issued in WA

Practice address

8824 96TH St NW
Gig Harbor, WA 98332-6303

Phone

(360) 600-7269

NPI assigned

May 2, 2008

Last updated

Aug 13, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376352000000",
    "number": "1104092857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8824 96TH ST NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983326303",
            "telephone_number": "360-600-7269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8824 96TH ST NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983326303",
            "telephone_number": "360-600-7269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUM",
        "first_name": "STEPHANIE",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-02",
        "last_updated": "2013-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WA",
            "license": "AP60071587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS",
            "identifier": "8507568",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G8917373",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "8871633",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• David Blunk, LMP
• Sara Boelman, MS, LMFT
• Annemarie Boeve
• Dillon Boland
• Amanda Boley, MA

• Primary Care Nurse Practitioner in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Primary Care Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.