Provider Demographics
NPI:1639435373
Name:BAXTER, KATRINA MARIE (MSN, NP-C)
Entity Type:Individual
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First Name:KATRINA
Middle Name:MARIE
Last Name:BAXTER
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Gender:F
Credentials:MSN, NP-C
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:CARDIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6633
Mailing Address - Fax:414-805-6280
Practice Address - Street 1:3237 S 16TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4526
Practice Address - Country:US
Practice Address - Phone:414-647-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2015-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI4982-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1639435373Medicaid