Basic Information
Provider Information
NPI: 1043599194
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAADE
FirstName: LINDSEY
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: APNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 22487
Address2:  
City: GREEN BAY
State: WI
PostalCode: 543052487
CountryCode: US
TelephoneNumber: 9204457226
FaxNumber:  
Practice Location
Address1: 820 ARBUTUS AVE
Address2:  
City: OCONTO
State: WI
PostalCode: 541532004
CountryCode: US
TelephoneNumber: 9208351100
FaxNumber: 9208351099
Other Information
ProviderEnumerationDate: 08/08/2011
LastUpdateDate: 09/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X4488-33WIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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