Liam Michael Bahneman
Individual provider Active NPI Nurse's Aide · Madison, WI
NPI 1003612482 · NPPES record last updated Feb 24, 2025
Key facts
- NPI
- 1003612482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse's Aide 376K00000X
- License
- WI037940401582 (WI)
- Practice address
- 801 Braxton PL
Madison, WI 53715-1415 - Phone
- (608) 260-2700
- NPI assigned
- Feb 24, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10866195 | MN | MD | Nurse's Aide |
| WI037940401582 | WI | MD | Nurse's Aide |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 10866195 | MN | |
| Nurse's Aide | 376K00000X | WI037940401582 | WI | Yes |
Addresses
Primary practice location
801 Braxton PL
Madison, WI 53715-1415
Mailing address
625 Babcock Dr
Madison, WI 53706-1204
Phone (612) 432-7219
Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.