Individual
MR. WAYNE BACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
2128-19
Contact information
Practice address
400 N MORRIS ST, STOUGHTON, WI 53589-1857
(608) 873-5651
Mailing address
400 N MORRIS ST, STOUGHTON, WI 53589-1857
(608) 873-5651
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2128-19
WI
Other
Enumeration date
05/22/2014
Last updated
05/22/2014
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