Provider Demographics
NPI:1902293855
Name:BLUNTACH, JOANNAH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOANNAH
Middle Name:
Last Name:BLUNTACH
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 RICHARD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2979
Mailing Address - Country:US
Mailing Address - Phone:612-429-1011
Mailing Address - Fax:855-631-0016
Practice Address - Street 1:4135 RICHARD AVE STE 201
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-2979
Practice Address - Country:US
Practice Address - Phone:612-429-1011
Practice Address - Fax:855-631-0016
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 3842363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health