Provider Demographics
NPI:1174531529
Name:BLIFFERT, KOREEN (CRT)
Entity type:Individual
Prefix:MRS
First Name:KOREEN
Middle Name:
Last Name:BLIFFERT
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:KOREEN
Other - Middle Name:
Other - Last Name:MARKEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-6287
Mailing Address - Country:US
Mailing Address - Phone:262-544-1184
Mailing Address - Fax:
Practice Address - Street 1:4848 S 76TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4361
Practice Address - Country:US
Practice Address - Phone:414-282-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2793-0282278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Rehabilitation