Provider Demographics
NPI:1356671259
Name:BLOMDAHL, SHARON MARIE (LPN/RCS)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:MARIE
Last Name:BLOMDAHL
Suffix:
Gender:F
Credentials:LPN/RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11226 W JANESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2401
Mailing Address - Country:US
Mailing Address - Phone:414-525-0515
Mailing Address - Fax:
Practice Address - Street 1:11226 W JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2401
Practice Address - Country:US
Practice Address - Phone:414-525-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33596-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse