Individual
BRENDA K BALTHAZOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
512 S 28TH AVE, WAUSAU, WI 54401-4147
(715) 847-2021
(715) 847-2325
Mailing address
512 S 28TH AVE, WAUSAU, WI 54401-4147
(715) 847-2021
(715) 847-2325
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
186923
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42871300
—
WI
Enumeration date
07/12/2006
Last updated
04/08/2020
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