Ryatisima Tishara Blue, LPN
Individual provider Active NPI Licensed Practical Nurse · Whitewater, WI
NPI 1568720795 · NPPES record last updated Apr 25, 2012
Key facts
- NPI
- 1568720795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 302318-31 (WI)
- Practice address
- 1130 Bloomingfield Dr Apt 19
Whitewater, WI 53190-2652 - Phone
- (262) 215-3379
- NPI assigned
- Apr 25, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302318-31 | WI | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 302318-31 | WI | Yes |
Addresses
Primary practice location
1130 Bloomingfield Dr Apt 19
Whitewater, WI 53190-2652
Mailing address
1130 Bloomingfield Dr Apt 19
Whitewater, WI 53190-2652
Phone (262) 215-3379
Other providers in Whitewater, WI
- Amy L Barth
- Shannon Bashor
- Kimberly Bavis
- Ali Benson
- Nathaniel Stuart Besch
- Lesley Loraine Blum
- Mikayla Lynn Boettner
- Lisa K Brellenthin
- Cheryl Bresnahan
- Forrest Lee Bright
All providers in Whitewater, WI · Licensed Practical Nurse in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.