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Contact Information

BRENDA K BALTHAZOR, PA
512 S 28TH AVE
WAUSAU, WI54401-4147
 Phone: 715-847-2021
 Fax: 715-847-2325
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for BRENDA K BALTHAZOR · (Female)

NPI # 1851316871
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 07/12/2006
Last updated 04/08/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 186923
  • WI Medicaid 42871300
Hospital affiliation(s)
  • ASPIRUS WAUSAU HOSPITAL - (Acute Care)
    333 PINE RIDGE BLVD
    WAUSAU, WI 54401
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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