Individual
STEPHANIE NICOLE BLAHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5900 S LAKE DR, CUDAHY, WI 53110-3171
(414) 489-9000
(414) 489-4153
Mailing address
5900 S LAKE DR, CUDAHY, WI 53110-3171
(414) 489-9000
(414) 489-4153
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085.007939
IL
363A00000X
Physician Assistant
Primary
5115-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100184745
—
WI
Enumeration date
08/21/2020
Last updated
10/06/2023
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