Healthcare Provider Details

I. General information

NPI: 1417386871
Provider Name (Legal Business Name): ANNELIESE KAY WILHELM APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNELIESE KAY BAUER

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/30/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PINE ST
LA CROSSE WI
54601-3481
US

IV. Provider business mailing address

230 PINE ST
LA CROSSE WI
54601-3481
US

V. Phone/Fax

Practice location:
  • Phone: 608-668-2103
  • Fax:
Mailing address:
  • Phone: 608-668-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5565
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5565
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: