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General NPI Number Information
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NPI Number | 1407647605
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Entity Type | Individual
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Provider Name | BAILEY ANN BASTERASH RN
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Gender | Female
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 8901 W LINCOLN AVE
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City | WEST ALLIS
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State | WI
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Zip | 53227-2409
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Country | US
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Telephone | 414-328-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 CRESTVIEW DR
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City | WATERTOWN
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State | WI
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Zip | 53094-5904
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 1105691
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License Number State | WI
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