Organization
BAYCARE CLINIC LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HETTMANN (SENIOR PROVIDER CREDENTIALING COORD)
(920) 490-9046
Entity
Organization
Contact information
Practice address
920 E 5TH ST, SHAWANO, WI 54166-2212
(715) 524-2001
(715) 524-6267
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 490-9046
(920) 405-5384
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
01/26/2012
Last updated
04/13/2022
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