Basic Information
| Provider Information | |||||||||
| NPI: | 1245663624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLOMKALNS | ||||||||
| FirstName: | PAUL | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 HOUMA BLVD | ||||||||
| Address2: | FL 6 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044544331 | ||||||||
| FaxNumber: | 5044544341 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 HOUMA BLVD | ||||||||
| Address2: | FL 6 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044544331 | ||||||||
| FaxNumber: | 5044544341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2013 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AP07513 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.