Provider Demographics
NPI:1982410031
Name:BASESKI, ILKAY N/A
Entity type:Individual
Prefix:MISS
First Name:ILKAY
Middle Name:N/A
Last Name:BASESKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COURT ST S UNIT 215
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-3206
Mailing Address - Country:US
Mailing Address - Phone:715-440-1693
Mailing Address - Fax:
Practice Address - Street 1:400 COURT ST S UNIT 215
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-3206
Practice Address - Country:US
Practice Address - Phone:715-440-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI595729133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered