Dianne Eileen Blust, ANP
Individual provider Active NPI Adult Health Nurse Practitioner · Canby, OR
NPI 1366445439 · NPPES record last updated Oct 18, 2010
Key facts
- NPI
- 1366445439
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 200150096 (OR)
- Practice address
- 1185 S Elm St
Canby, OR 97013-3935 - Phone
- (503) 723-4670
- Fax
- (503) 266-6649
- NPI assigned
- May 23, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200150096 | OR | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willamette Hematology-Oncology PC | Past | Accepting new patients | |
| Pacific Medical Group, PC | Past | Accepting new patients | |
| Northwest Cancer Specialists PC | Past |
Accepting new patients |
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61288
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 200150096 | OR | Yes |
Addresses
Primary practice location
1185 S Elm St
Canby, OR 97013-3935
Mailing address
6 Centerpointe Dr
Ste 200
Lake Oswego, OR 97035-8653
Phone (503) 797-2268
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 275246 | Medicaid | OR |
Other providers in Canby, OR
- Christopher M Berberian
- Nancy Ellen Bernstetter
- Daniel Birt
- Jennifer Bissig
- Anna Fehm Blake
- Tyler Marc Bohnet
- Gary M Bold
- Misty M Bonham
- Briana Nichole Booth
- Zachary Borden
All providers in Canby, OR · Adult Health Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.