Individual
BRIANNA LYNN BAETEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2253 W MASON ST, GREEN BAY, WI 54303-4706
(920) 327-7300
Mailing address
4840 N LATITUDE LN UNIT H, APPLETON, WI 54913-9431
(920) 676-2105
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5338-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100153241
—
WI
Enumeration date
02/12/2020
Last updated
11/19/2021
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