Provider Demographics
NPI:1134144116
Name:BAIRD, HARVEY ALLEN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:HARVEY
Middle Name:ALLEN
Last Name:BAIRD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1871
Mailing Address - Country:US
Mailing Address - Phone:715-531-1256
Mailing Address - Fax:715-531-1258
Practice Address - Street 1:601 SPRUCE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1871
Practice Address - Country:US
Practice Address - Phone:715-269-5530
Practice Address - Fax:715-269-5535
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI89463-030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI89463-030OtherRN NUMBER
WI44321700Medicaid