Provider Demographics
NPI:1518439033
Name:BLAKEMAN, LEAH M (APNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:BLAKEMAN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 WOODRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1328
Mailing Address - Country:US
Mailing Address - Phone:608-617-3269
Mailing Address - Fax:
Practice Address - Street 1:801 S 70TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3147
Practice Address - Country:US
Practice Address - Phone:414-773-6600
Practice Address - Fax:414-773-6656
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily