Provider Demographics
NPI:1427349745
Name:BLOMENKAMP, WILLIAM RICHARD (RN, ACRN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RICHARD
Last Name:BLOMENKAMP
Suffix:
Gender:M
Credentials:RN, ACRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 STONY POINT RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-8912
Mailing Address - Country:US
Mailing Address - Phone:865-465-3862
Mailing Address - Fax:
Practice Address - Street 1:405 DANTE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-9719
Practice Address - Country:US
Practice Address - Phone:865-215-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000177966163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health