Provider Demographics
NPI:1104897412
Name:BAHDE, LYNDA J (APNP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:J
Last Name:BAHDE
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:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:2935 SHORE DR
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4237
Practice Address - Country:US
Practice Address - Phone:715-732-9193
Practice Address - Fax:715-732-9196
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1704-033363LF0000X
MI4704200437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43914800Medicaid
MIN41200025Medicare Oscar/Certification
WI4825080010Medicare NSC
WIP13015Medicare UPIN
WI43914800Medicaid
WIP00304235Medicare Oscar/Certification