Healthcare Provider Details

I. General information

NPI: 1366100448
Provider Name (Legal Business Name): WENDY LOU BLISH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENDY LOU YAHNKE NA

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 COLLEGE AVE STE M1
SOUTH MILWAUKEE WI
53172-1150
US

IV. Provider business mailing address

2814 S 108TH ST
WEST ALLIS WI
53227-3224
US

V. Phone/Fax

Practice location:
  • Phone: 414-775-2500
  • Fax:
Mailing address:
  • Phone: 414-885-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number105681-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: