Individual
SAMANTHA GOEKE BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
W180N8000 TOWN HALL RD, MENOMONEE FALLS, WI 53051-4002
(262) 532-3600
Mailing address
W180N8000 TOWN HALL RD, MENOMONEE FALLS, WI 53051-4002
(262) 532-3600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/23/2015
Last updated
10/06/2017
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