Organization
T.D.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER BLAHNIK O.M.D. (SUPERVISOR)
(715) 675-6771
Entity
Organization
Contact information
Practice address
3000 EMERY DR, WAUSAU, WI 54401-9710
(715) 675-6771
Mailing address
3000 EMERY DR, WAUSAU, WI 54401-9710
(715) 675-6771
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
541-0001
WI
Other
Enumeration date
08/05/2007
Last updated
08/05/2007
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