Provider Demographics
NPI:1699089698
Name:RATHJEN, BLAIR M (PA)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:M
Last Name:RATHJEN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:710 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1941
Mailing Address - Country:US
Mailing Address - Phone:715-256-3062
Mailing Address - Fax:715-256-3089
Practice Address - Street 1:710 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1941
Practice Address - Country:US
Practice Address - Phone:715-256-3000
Practice Address - Fax:715-256-3019
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2021-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant