Individual
THERESA J BASELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
210 WISCONSIN AMERICAN DR, FOND DU LAC, WI 54937-2999
(920) 907-7000
(920) 907-7012
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 389-2377
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2688-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41272800
—
WI
Enumeration date
03/21/2006
Last updated
11/22/2021
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