Healthcare Provider Details

I. General information

NPI: 1619262995
Provider Name (Legal Business Name): CAITLIN ELIZABETH BAUMGARDNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD BLDG 98
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

2510 WITTKOP WAY APT. 84
SACRAMENTO CA
95825-5113
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7520
  • Fax:
Mailing address:
  • Phone: 707-367-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number712725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: