Provider Demographics
NPI:1245552074
Name:BLUME, OLIVIA ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ROSE
Last Name:BLUME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1296 E HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7324
Mailing Address - Country:US
Mailing Address - Phone:520-999-1598
Mailing Address - Fax:
Practice Address - Street 1:2426 N MERRITT CREEK LOOP STE A
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4961
Practice Address - Country:US
Practice Address - Phone:208-819-2183
Practice Address - Fax:208-209-6063
Is Sole Proprietor?:No
Enumeration Date:2010-02-21
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA61659218363A00000X
AZ4441363A00000X
ID7971040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant