Healthcare Provider Details

I. General information

NPI: 1144397209
Provider Name (Legal Business Name): CAROL ANN BAXTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 S LINCOLN AVE
URBANA IL
61801-4703
US

IV. Provider business mailing address

1109 S LINCOLN AVE
URBANA IL
61801-4703
US

V. Phone/Fax

Practice location:
  • Phone: 217-333-2705
  • Fax: 217-244-1758
Mailing address:
  • Phone: 217-333-2705
  • Fax: 217-244-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: