Annika Lee Blaine

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

6070 Issued in MN

Practice address

1700 University Ave W
Saint Paul, MN 55104-3727

Phone

(612) 232-2002

NPI assigned

Aug 2, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1533168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543104000000",
    "number": "1699253468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 OAKBROOKE DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224205",
            "telephone_number": "612-226-3385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043727",
            "telephone_number": "612-232-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAINE",
        "first_name": "ANNIKA",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-02",
        "last_updated": "2018-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "1991914",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "6070",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "6070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFIED NURSE PRACTITIONER LICENSE",
            "identifier": "6070",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "241607",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "1991914",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian E. Blackwell, DDS
• Rebecca Lynn Blackwell
• Alisa Blackwood, CD(DONA)
• Garrett Franklin Blaha, RN
• Haley Anne Blahnik, PA-C
• Jonathan Blair
• David P Blake, MD
• Sandra Lee Blake, RD, LD
• Joseph Blakeslee, DNP, CNP, PMHNP-BC
• Briana Blakey, LPCC

• Gerontology Nurse Practitioner in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Gerontology Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2018; 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.