Healthcare Provider Details

I. General information

NPI: 1366355992
Provider Name (Legal Business Name): JAMIE BAHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WESTERN AVE
MANITOWOC WI
54220-3712
US

IV. Provider business mailing address

W4193 COUNTY LINE RD
ELKHART LAKE WI
53020-1723
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-2011
  • Fax:
Mailing address:
  • Phone: 920-286-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1915833
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: