Blackwell, Connie Sue

Blackwell, Connie Sue is an individual health care provider with primary practice located at 10081 Dogwood St Nw Suite 100, Coon Rapids MN 55448-5281. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Blackwell, Connie Sue can be contacted via phone (763) 783-3722.

Contact Information

Primary practice address
10081 Dogwood St Nw Suite 100 Coon Rapids MN 55448-5281
Phone: (763) 783-3722
Fax: (763) 783-7944
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X A0813103 Minnesota

Profile Details

NPI number 1437195823
LBN Legal business name Blackwell, Connie Sue
Credentials RN CNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2006
Last updated Oct 13th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437195823 NPPES
Minnesota MEDICAID 2911984200
Minnesota Other 31257BL
Minnesota Other 1203352

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