Active NPI
Elizabeth Blanke
- Gerontology Nurse Practitioner
- Council Bluffs, IA
National Provider Identifier
1407107576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- J-127693
- Practice address
- 1702 N 16TH St
Council Bluffs, IA 51501-0121 - Phone
- (712) 256-7223
- Fax
- (712) 256-7669
- NPI assigned
- Sep 28, 2012
- Last updated
- Oct 8, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | J-127693 | IA | Primary |
Addresses
Primary practice location
1702 N 16TH St
Council Bluffs, IA 51501-0121
Mailing address
1306 N 52ND St
Omaha, NE 68132-1420
Phone (402) 332-6706
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 |
|---|---|---|---|
| J-127693 | IA | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pace Iowa | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349654400000",
"number": "1407107576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1306 N 52ND ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681321420",
"telephone_number": "402-332-6706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1702 N 16TH ST",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515010121",
"telephone_number": "712-256-7223",
"fax_number": "712-256-7669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANKE",
"first_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-28",
"last_updated": "2012-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "IA",
"license": "J-127693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.