Provider Demographics
NPI:1891450151
Name:WILDMAN, BAYLEE E (PA-C)
Entity type:Individual
Prefix:
First Name:BAYLEE
Middle Name:E
Last Name:WILDMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:330 N WABASH AVE STE 360
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2678
Practice Address - Country:US
Practice Address - Phone:765-664-3292
Practice Address - Fax:765-662-7560
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2024-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10003381A363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant