Provider Demographics
NPI:1780152736
Name:BESSETTE, ANNELIESE (APNP)
Entity type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:
Last Name:BESSETTE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9889 COUNTY ROAD D
Mailing Address - Street 2:
Mailing Address - City:ALMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54909-9561
Mailing Address - Country:US
Mailing Address - Phone:715-451-0472
Mailing Address - Fax:
Practice Address - Street 1:2401 PLOVER RD
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-3916
Practice Address - Country:US
Practice Address - Phone:715-295-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8859-33207Q00000X
WI8859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine