| NPI | 1356524870 |
|---|---|
| Former Name | SHAE M ELLEFSON/BLAKLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2741-23) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 664-039) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2015-04-09 |