| Doctor Name: | MRS. MANDY RAE BLUME |
| NPI Number: | 1134378433 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS RN CGNP |
| License Number: | R156724-1 |
| Business Practice Address: | 4810 197th St E Faribault, MN - 550218078 |
| Business Phone Number: | 5073332748 |
| Business Fax Number: | |
| Mailing Address: | 4810 197th St E, FARIBAULT |
| State: | MN |
| Postal Code: | 550218078 |
| Phone Number: | 5073332748 |
| Fax Number: | |
| NPI Enumeration Date: | 09/11/2008 |
| NPI Last Update Date: | 12/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | R156724-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |