Healthcare Provider Details

I. General information

NPI: 1811394877
Provider Name (Legal Business Name): AURORA BAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 KEPLER DR
GREEN BAY WI
54311-8321
US

IV. Provider business mailing address

1160 KEPLER DR
GREEN BAY WI
54311-8321
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-5459
  • Fax: 920-288-5420
Mailing address:
  • Phone: 920-288-5459
  • Fax: 920-288-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number5572-26
License Number StateWI

VIII. Authorized Official

Name: DIANNE LEZOTTE
Title or Position: NETWORK CREDENTIALING COORD SR
Credential:
Phone: 414-647-6326