Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 65723 | WI |
NPI | 1205152824 |
---|---|
Provider Name | Stephanie Lynn Bakey |
First Address | Green Bay, WI 54307-9070 |
Second Address | Green Bay, WI 54301-3526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2010 |
Last Update Date | 05/08/2016 |