Provider Demographics
NPI:1225305758
Name:BAIRD, SUSAN KING (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KING
Last Name:BAIRD
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:G
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:1511 N WUTHERING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-3407
Mailing Address - Country:US
Mailing Address - Phone:814-335-2972
Mailing Address - Fax:
Practice Address - Street 1:3200 E RACINE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2343
Practice Address - Country:US
Practice Address - Phone:608-371-8000
Practice Address - Fax:608-371-8938
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI192873-30163W00000X
PASP011662363L00000X
WI5045-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100025926Medicaid