Active NPI
Sydney Li Blaine
- Certified Registered Nurse Anesthetist
- Fond Du Lac, WI
National Provider Identifier
1215801972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- STUDENT
- Practice address
- 1004 Bluehill Ave
Fond Du Lac, WI 54935-7602 - Phone
- (920) 904-4807
- NPI assigned
- Oct 3, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | STUDENT | WI | Primary |
Addresses
Primary practice location
1004 Bluehill Ave
Fond Du Lac, WI 54935-7602
Mailing address
1004 Bluehill Ave
Fond Du Lac, WI 54935-7602
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| STUDENT | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1759449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761264000000",
"number": "1215801972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1004 BLUEHILL AVE",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549357602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1004 BLUEHILL AVE",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549357602",
"telephone_number": "920-904-4807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAINE",
"first_name": "SYDNEY",
"middle_name": "LI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-10-03",
"last_updated": "2025-10-24",
"certification_date": "2025-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "WI",
"license": "STUDENT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.