Organization
BAYCARE CLINIC, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HETTMANN CPCS (SR. PROVIDER CREDENTIALING COORD.)
(920) 490-9046
Entity
Organization
Contact information
Practice address
1111 BAYSHORE DRIVE, MANITOWOC, WI 54220
(920) 490-9046
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208800000X
Urology Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
03/23/2021
Last updated
08/23/2022
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