Provider Demographics
NPI:1013023597
Name:BACKUS, BARBARA J (NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:BACKUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-4500
Mailing Address - Fax:920-682-9378
Practice Address - Street 1:1650 S 41ST ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-7316
Practice Address - Country:US
Practice Address - Phone:920-320-4500
Practice Address - Fax:920-682-9378
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI87844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI390806395OtherWEA
WI43921300Medicaid
WI50015958OtherMEDICARE RAILROAD
WIP07429OtherCIGNA
WI1003306OtherTOUCHPOINT
WI31926OtherNETWORK HEALTH
WI390806395OtherCHAMPUS
WI390806395008OtherTRICARE
WI390806395OtherWEA
WI31926OtherNETWORK HEALTH