Organization
BAYCARE CLINIC, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HETTMANN (PROVIDER CREDENTIALING COORDINATOR)
(920) 490-9046
Entity
Organization
Contact information
Practice address
835 S MAIN ST, OCONTO FALLS, WI 54154-1282
(888) 376-3876
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Enumeration date
01/07/2019
Last updated
03/31/2022
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