Provider Demographics
NPI:1366018558
Name:BLIMLING, SUZANNE (AGNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BLIMLING
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7930 US HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:WI
Mailing Address - Zip Code:54515-9240
Mailing Address - Country:US
Mailing Address - Phone:262-794-2414
Mailing Address - Fax:
Practice Address - Street 1:1000 COLLEGE AVE W
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-2118
Practice Address - Country:US
Practice Address - Phone:715-532-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI11021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program