Provider Demographics
NPI:1871954768
Name:BLUST, ANNETTE MARIE (APRN)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIE
Last Name:BLUST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8129
Mailing Address - Country:US
Mailing Address - Phone:614-850-2407
Mailing Address - Fax:614-876-8747
Practice Address - Street 1:4961 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-8129
Practice Address - Country:US
Practice Address - Phone:614-850-2407
Practice Address - Fax:614-876-8747
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0383163Medicaid