Provider Demographics
NPI:1366100448
Name:BLISH, WENDY LOU (RN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LOU
Last Name:BLISH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LOU
Other - Last Name:YAHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA
Mailing Address - Street 1:2814 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-3224
Mailing Address - Country:US
Mailing Address - Phone:414-885-3525
Mailing Address - Fax:
Practice Address - Street 1:1333 COLLEGE AVE STE M1
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-1150
Practice Address - Country:US
Practice Address - Phone:414-775-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI105681-30163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty