Individual
MRS. TRISHA ANN BACKUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1118 DIVISION ST, GREEN BAY, WI 54303-3002
(920) 884-9981
Mailing address
1118 DIVISION ST, GREEN BAY, WI 54303-3002
(920) 884-9981
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
149463030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35033000
—
WI
Enumeration date
09/18/2007
Last updated
04/09/2010
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