Healthcare Provider Details

I. General information

NPI: 1275629511
Provider Name (Legal Business Name): JANET L BAUGH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WOOD ST
LOOGOOTEE IN
47553-1260
US

IV. Provider business mailing address

695 3RD AVE
JASPER IN
47546-3602
US

V. Phone/Fax

Practice location:
  • Phone: 812-295-2955
  • Fax: 812-295-2573
Mailing address:
  • Phone: 812-634-6824
  • Fax: 812-481-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001604A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: