Healthcare Provider Details

I. General information

NPI: 1386875813
Provider Name (Legal Business Name): TERESA L BAIRD BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 ST ANDREW STREET
LACROSSE WI
54603-2378
US

IV. Provider business mailing address

W15674 DOPP RD PO BOX 252
ETTRICK WI
54627-9311
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-6354
  • Fax:
Mailing address:
  • Phone: 608-525-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number107486030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: