Ward, Blake R

Ward, Blake R is an individual health care provider with primary practice located at 1626 Tuttle St , Baraboo WI 53913-1501. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Ward, Blake R can be contacted via phone (608) 355-6868.

Contact Information

Primary practice address
1626 Tuttle St Baraboo WI 53913-1501
Phone: (608) 355-6868
Fax: (608) 356-6787
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 4178-023 Wisconsin

Profile Details

NPI number 1922527365
LBN Legal business name Ward, Blake R
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 18th, 2017
Last updated Dec 20th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922527365 NPPES
Wisconsin MEDICAID 1922527365

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