Active NPI
Blanche Eaton
- Preferred Provider Organization
- Minneapolis, MN
National Provider Identifier
1629477633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Preferred Provider Organization
- License
- 3675466
- Practice address
- 1502 W Broadway Ave
Minneapolis, MN 55411-2408 - Phone
- (612) 529-2399
- Fax
- (612) 529-2399
- NPI assigned
- Aug 14, 2014
- 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 |
|---|---|---|---|---|
| Preferred Provider Organization | 305R00000X | 3675466 | MN | Primary |
Addresses
Primary practice location
1502 W Broadway Ave
Minneapolis, MN 55411-2408
Mailing address
1502 W Broadway Ave
Minneapolis, MN 55411-2408
Phone (612) 529-2399
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 |
|---|---|---|---|
| 3675466 | MN | MD | Preferred Provider Organization |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407974400000",
"number": "1629477633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1502 W BROADWAY AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554112408",
"telephone_number": "612-529-2399",
"fax_number": "612-529-2399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1502 W BROADWAY AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554112408",
"telephone_number": "612-529-2399",
"fax_number": "612-529-2399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EATON",
"first_name": "BLANCHE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-14",
"last_updated": "2014-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "305R00000X",
"taxonomy_group": "",
"desc": "Preferred Provider Organization",
"state": "MN",
"license": "3675466",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.