Organization
BAYCARE CLINIC, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HETTMANN (PROVIDER CREDENTIALING COORDINATOR)
(920) 490-9046
Entity
Organization
Contact information
Practice address
1217 ELLIS ST, KEWAUNEE, WI 54216-1825
(877) 462-9465
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
12/28/2018
Last updated
04/20/2022
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