Individual
BLOSSOM MANDY FELICIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2323 S 109TH ST STE 130B, WEST ALLIS, WI 53227-1909
(414) 334-5224
Mailing address
2323 S 109TH ST STE 130B, WEST ALLIS, WI 53227-1909
(414) 334-5224
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
2900134
WI
Other
Enumeration date
05/04/2022
Last updated
05/04/2022
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