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Individual

MS. RYATISIMA TISHARA BLUE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
1130 BLOOMINGFIELD DR APT 19, WHITEWATER, WI 53190-2652
(262) 215-3379
Mailing address
1130 BLOOMINGFIELD DR APT 19, WHITEWATER, WI 53190-2652
(262) 215-3379

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
302318-31
WI

Other

Enumeration date
04/25/2012
Last updated
04/25/2012
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