Healthcare Provider Details

I. General information

NPI: 1942439898
Provider Name (Legal Business Name): LELA BLAND APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LELA PEAVY RN

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 05/25/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 W RESEARCH DR
MILWAUKEE WI
53226-3452
US

IV. Provider business mailing address

7544 N 53RD ST
MILWAUKEE WI
53223-4808
US

V. Phone/Fax

Practice location:
  • Phone: 414-443-4598
  • Fax:
Mailing address:
  • Phone: 414-357-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13997-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number137770-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: