Individual
LIESL MARIE BLETHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1051 W RAND RD # 110, ARLINGTON HEIGHTS, IL 60004-2315
(847) 618-9292
(847) 618-9294
Mailing address
1051 W RAND RD # 110, ARLINGTON HEIGHTS, IL 60004-2315
(847) 618-9292
(847) 618-9294
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.006257
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085006257
STATE LICENSE
IL
Enumeration date
07/06/2017
Last updated
10/12/2022
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