Provider Demographics
NPI:1609866045
Name:BASTIAN, VIRGINIA (APRN)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4376 S 52ND ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3570
Mailing Address - Country:US
Mailing Address - Phone:414-520-5483
Mailing Address - Fax:
Practice Address - Street 1:1028 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1335
Practice Address - Country:US
Practice Address - Phone:414-643-6441
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63658-030163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43987300Medicare ID - Type UnspecifiedNURSE PRACTITIONER