Healthcare Provider Details

I. General information

NPI: 1801260898
Provider Name (Legal Business Name): MRS. ERICA RACHELLE BAUMGARTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 WITTENBRAKER AVE
NEW CASTLE IN
47362-5035
US

IV. Provider business mailing address

152 WITTENBRAKER AVE
NEW CASTLE IN
47362-5035
US

V. Phone/Fax

Practice location:
  • Phone: 812-621-0453
  • Fax:
Mailing address:
  • Phone: 812-621-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28197170A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006087A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: