Basic Information
| Provider Information | |||||||||
| NPI: | 1518439033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAKEMAN | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3105 WOODRIDGE LN | ||||||||
| Address2: | |||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531881328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086173269 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 S 70TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532143147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147736600 | ||||||||
| FaxNumber: | 4147736656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2018 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 8471 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.