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NPI Code Detail

MEDICARE: MISS RENEE L BLAHA PA-C

MEDICARE: MISS RENEE L BLAHA PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1962WI
2363A00000XPhysician Assistant9828MN
3363A00000XPhysician Assistant0499SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396700449
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS RENEE L BLAHA PA-C
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-328-6585
Fax Number : 605-312-9802
Provider Business Practice Location Address
First Line : 1210 W 18TH ST STE G01
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-4651
Country : US
Telephone Number : 605-328-2663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 03/10/2022

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Directions to “ MISS RENEE L BLAHA PA-C” Practice Location

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