NPIMap

Organization Active NPI

Blossom Wellness LLC

  • Clinic/Center
  • Oakdale, MN
National Provider Identifier
1164289690
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
BLOSSOM WELLNESS LLC
Practice address
625 Hayward Ave N
Oakdale, MN 55128-7127
Phone
(651) 410-7955
NPI assigned
Mar 1, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Elvis Tambi Starllone, CNPNPI 1942723143
Title
Owner
Phone
(651) 410-7955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

625 Hayward Ave N
Oakdale, MN 55128-7127

Mailing address

625 Hayward Ave N
Oakdale, MN 55128-7127
Phone (651) 410-7955

National Provider Directory

National Provider Directory

Locations

625 Hayward Ave N
Saint Paul, MN 55128
Phone (651) 327-0849

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1709251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1164289690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 HAYWARD AVE N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551287127",
            "telephone_number": "651-410-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 HAYWARD AVE N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551287127",
            "telephone_number": "651-410-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-01",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "STARLLONE",
        "authorized_official_first_name": "ELVIS",
        "authorized_official_middle_name": "TAMBI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-410-7955",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakdale, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.