Provider Demographics
NPI:1063945483
Name:BATHE, JEMSTONE WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JEMSTONE
Middle Name:WESLEY
Last Name:BATHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2215 FOLSOM ST APT 123
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2416
Mailing Address - Country:US
Mailing Address - Phone:574-575-2768
Mailing Address - Fax:
Practice Address - Street 1:1700 W STOUT ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-5000
Practice Address - Country:US
Practice Address - Phone:715-236-8164
Practice Address - Fax:715-236-8322
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI73481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine