Healthcare Provider Details

I. General information

NPI: 1043789183
Provider Name (Legal Business Name): ALESIA JO BAXTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 10TH ST
ATLANTIC IA
50022-1935
US

IV. Provider business mailing address

1500 E 10TH ST
ATLANTIC IA
50022-1935
US

V. Phone/Fax

Practice location:
  • Phone: 712-243-2606
  • Fax: 712-243-2688
Mailing address:
  • Phone: 712-243-2606
  • Fax: 712-243-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number130747
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: