| Doctor Name: | DIANNE EILEEN BLUST |
| NPI Number: | 1366445439 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | 200150096 |
| Business Practice Address: | 1185 S Elm St Canby, OR - 970133935 |
| Business Phone Number: | 5037234670 |
| Business Fax Number: | 5032666649 |
| Mailing Address: | 6 Centerpointe Dr, Ste 200 LAKE OSWEGO |
| State: | OR |
| Postal Code: | 970358653 |
| Phone Number: | 5037972268 |
| Fax Number: | 5032348227 |
| NPI Enumeration Date: | 05/23/2005 |
| NPI Last Update Date: | 10/18/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 200150096 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |