Provider Demographics
NPI:1811394877
Name:AURORA BAYCARE
Entity Type:Organization
Organization Name:AURORA BAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NETWORK CREDENTIALING COORD SR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEZOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-647-6326
Mailing Address - Street 1:1160 KEPLER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8321
Mailing Address - Country:US
Mailing Address - Phone:920-288-5459
Mailing Address - Fax:920-288-5420
Practice Address - Street 1:1160 KEPLER DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-8321
Practice Address - Country:US
Practice Address - Phone:920-288-5459
Practice Address - Fax:920-288-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5572-26283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital