Provider Demographics
NPI:1710515077
Name:BAER, NICHOLAS LYLE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LYLE
Last Name:BAER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19024 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6727
Mailing Address - Country:US
Mailing Address - Phone:608-865-0855
Mailing Address - Fax:
Practice Address - Street 1:2820 E PARK AVE
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3598
Practice Address - Country:US
Practice Address - Phone:715-723-5542
Practice Address - Fax:715-723-7957
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
WI5533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program