Provider Demographics
NPI:1386064749
Name:BLASKOWSKI, JULIE E
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:E
Last Name:BLASKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 DEER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-4437
Mailing Address - Country:US
Mailing Address - Phone:218-736-7945
Mailing Address - Fax:218-736-4250
Practice Address - Street 1:1916 DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-4437
Practice Address - Country:US
Practice Address - Phone:218-736-7945
Practice Address - Fax:218-736-4250
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1006853-8-AFC311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1006853-8-AFCOtherLICENSE